Fractures of Forearm Bones – Operative Methods of Treatment

Most of the fractures of both bones of forearm i.e. radius and ulna are treated by operative methods as non operative methods are not very successful especially in displaced fractures.

For closed fractures of these bones, the surgery is either fixation with plate and screws or intramedullary nailing.

Fixation With Plate and Screws

Stainless steel, limited-contact, dynamic compression plate is the treatment of choice for displaced fractures of the radius and ulna and provide very good results.

The preferred plate is the eight-hole dynamic compression plate with 3.5-mm cortical screws.

Though plate and screw combination takes care of most of fracture configurations, there are some situations like open fractures, segmental fractures, failed plating and multiple injuries  where nailing might be preferred.

Disadvantage of the plating is extensive soft tissue dissection and periosteal stripping. Advantage is ability of the surgeon to reduce and fix fractures in anatomical position.

Fixation with Intramedullary Nails

Though few people prefer operating segmental fractures using two plates, many other prefer nailing. Other indications of intramedullary nailing are open fractures, pathological fractures, polytrauma and multuiple failed surgeries. they are also used to treat paediatric fractures of  forearm, if required.

The theoretical advantages of intramedullary nailing include less periosteal stripping, the absence of diaphyseal stress risers, and a smaller operative wound.

There are various types of nails available for fixation of these fractures. Both locked and unlocked versions are available. Bail is a poor implant as compared to plating and should be reserved for selected incations. Anatomical reduction is of paramount importance in these fractures and that is difficult to achieve with nails.

Locked nails are prefered over the unlocked ones. Nail size needs to be exact otherwise various complications.

External Fixator In Forearm Fractures

External fixators are used in case of open injuries or massive soft tissue loss. They are useful especially as damage control exercise.

Related posts:

1. Open Fractures of Forearm Bones – Diagnosis and Treatment
2. Radiograph Fracture of Both Bones of forearm
3. Operative Treatment of Galeazzi Fracture – Tackling Distal Radioulnar Joint Instability
4. Treatment of Fractures of Radius and Ulna
5. Posttraumatic Radioulnar Synostosis Follwing Forearm Fractures