RESULTS OF CLOSED INTRAMEDULLARY NAILING VS PLATE OSTEOSYNTHESIS IN DIAPHYSEAL FRACTURES OF BOTH BONES FOREARM IN ADULTS

BACKGROUND: Plate osteosynthesis is the most commonly used technique for the treatment of diaphyseal forearm fractures in adults. However, application of a plate can disrupt the periosteal blood supply and necessitates skin incision that may be unsightly, and there is a risk of refracture if the implant is removed. The purpose of this study was to assess the early results of the use of closed intramedullary nail to stabilize displace diaphyseal fractures of both bones forearm. AIMS OF STUDY: 1.To evaluate the results of internal fixation of diaphyseal fractures of both bones forearm treated by plate osteosynthesis and closed intramedullary nailing. 2. To compare the functional results of the two groups treated with plate osteosynthesis and closed intramedullary nailing. 3. To review the literature on the treatment of diaphyseal fractures of forearm bones. METHODS: From September 2006 to October 2008 in the Department of Orthopaedics and Traumatology, Gandhi medical college and associated Hamidia Hospital, Bhopal, total of 38 patients of both bones forearm fractures were treated. Eighteen (18) patients with were treated with plate osteosynthesis and 20 patients with closed intramedullary nailing using the square nails. Total 31 patients were available for the follow up. Average follows up in plate osteosynthesis group was 14.1 months and in closed intramedullary nailing group was 15 months, with range from 12 months to 21 months. Functional results were assessed by Anderson et al criteria (1975). RESULTS: Average surgery time in plate osteosynthesis group was 68 minutes, and in closed nailing group was 43 minutes. In plate osteosynthesis group radius showed union in 14 (93.2%) patients and ulna in 13 (86.8%) of patients, in closed nailing group both radius and ulna resulted in 100% union rate. In plate osteosynthesis group there was 1 deep infection, 1 implant failure, and 3 nonunion. Functional results in plate osteosynthesis group were excellent in 12 (80%) of patient, satisfactory in 1(6.6%), failure in 2(13.2%). There was no unsatisfactory result in this group. In closed nailing group result were excellent in 11(68.7%), satisfactory in 4(24.8%), unsatisfactory in 1(6.2%) and no failure. CONCLUSIONS: Our experience indicates that the advantage of closed intramedullary nailing for fractures of both bones forearm are that it is technically straightforward, it allows high rate of osseous union, and it requires less surgical exposure and operative time, less risk of infection than does plate osteosynthesis for diaphyseal fractures of both bones forearm in adults. The disadvantage of this system is that post-operative immobilization is required until bridging callus is observed at the fracture site and radiation hazard to patient and surgeon. We conclude that closed intramedullary nailing is not superior to plate fixation but can be considered as an alternative to that method for diaphyseal forearm fractures in adults. KEYWORD: forearm nailing, forearm plating.