SURGICAL MANAGEMENT OF FRACTURE BOTH BONES FOREARM WITH LOCKING COMPRESSION PLATE IN ADULT PATIENTS
Objective: The objective of this study was to assess the time taken for surgery, tourniquet time, and clinical outcome in diaphyseal fractures of both forearms managed with locking compression plate (LCP).
Methods: Patients underwent open reduction and internal fixation with 3.5-mm LCP. Proximal radius was approached by dorsal Thompson incision and middle and distal radius by volar henry approach. A minimum of 6 cortices were engaged with screw fixation in each fragment. Ulna was approached directly over the subcutaneous border.
Results: Of 20 patients, 70% were men; fracture was the most common in second and third decades of life. Road traffic accident (50%) and fall (40%) were the main causes. Fractures at mid-diaphysis (70%) and transverse/short oblique (72.5%) were the most common. Closed head injury, unilateral pubic bone fracture, olecranon fracture, fracture of both bones of leg, and ipsilateral fracture shaft humerus were the associated injuries. There was no intraoperative complication. Superficial infection (n=01) and transient posterior interosseous nerve injury, in the immediate postoperative period (n=01), were the reported complications. Average time for surgery was 77 min (60–90 min) and that for tourniquet was 54 min (40–60 min). All had complete union in <6 months; 80% had healing in <4 months. 20% healed in 4–6 months. Excellent and satisfactory results were seen in 85% and 15% patients, respectively.
Conclusion: The 3.5-mm LCP, when applied properly, yields excellent outcome in fractures of forearm bones. The use of tourniquet, separate incisions for radius and ulna, and preservation of the natural curves of radius will reduce complications. Clinical outcome in terms of healing and union is excellent.
2. Reddy CC, Nazeer BS, Arun HS. A study of management of fractures of both bones forearm using locking compression plates. Int J Curr Res 2017;9:47593-8.
3. Frigg R. Development of the locking compression plate. Injury 2003;34 Suppl 2:B6-10.
4. Leung F, Chow SP. A prospective, randomized trial comparing the limited contact dynamic compression plate with the point contact fixator for forearm fractures. J Bone Joint Surg Am 2003;85-A:2343-8.
5. Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma 2004;18:488-93.
6. Leung F, Chow SP. Locking compression plate in the treatment of forearm fractures: A prospective study. J Orthop Surg (Hong Kong) 2006;14:291-4.
7. Haidukewych GJ. Innovations in locking plate technology. J Am Acad Orthop Surg 2004;12:205-12.
8. Dickson KF, Munz J. Locked plating: Clinical indications. Tech Orthop 2007;22:181-5.
9. Stevens CT, ten Duis HJ. Plate osteosynthesis of simple forearm fractures: LCP versus DC plates. Acta Orthop Belg 2008;74:180-3.
10. Meena RK, Singh AM, Langshong R, Waikhom S, Singh AK, Chishti SN. Internal fixation of adult diaphyseal both bone forearm fractures using locking compression plate. J Med Soc 2014;28:171-4.
11. Ranganath HD, Channappa TS, Suhas BD, Somashekhar S. A study of surgical management of fracture both bones forearm treated with limited contact dynamic compression plate and screws. Int J Orthop Sci 2017;3:785-91.
12. Sharma S, Dang H, Sharma V, Sharma S. Treatment of diaphyseal forearm bone fractures by locking compression plate (LCP). Internet J Orthop Surg 2008;2008:11.
13. Reddy BJ, Lingala A, Kathyayini R. Comparative study of forearm fractures treated with locking compression plate limited contact dynamic compression plate. J Evol Med Dent Sci 2015;4:2001-10.
14. Saikia K, Bhuyan S, Bhattacharya T, Borgohain M, Jitesh P, Ahmed F, et al. Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate. Indian J Orthop 2011;45:417-21.
15. Andrew HC. Fractures of shoulder girdle, arm and forearm. Ch. 49. In: Canale E, Tery S. Campbells Operative Orthopaedics. St. Louis, Mo: Mosby; 2013. P. 2829-916.
16. Perren SM. Basic aspect of internal fixation. Ch. 1. In: Muller ME, Allgower M, Scheider R, Willenegger H, editor. Manual of Internal Fixation. 3rd ed. Berlin: Springer Verlag; 1991. P. 240-2.
17. Anderson LD, Sisk D, Tooms RE, Park WI 3rd. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am 1975;57:287-97.
18. Chip ML. Forearm fractures. Ch. 14. In: Hausen ST, Swiontkowski MF. Orthopaedic Trauma Protocols. New York: Raven Press; 1993. p. 121-4. 19. Hansmann C. Eine neue mo?glichkeit der fixierung der frag- mente bei komplizierten frakturen. Verh dtsch Ges Chir 1886;3:158.
20. Sommer C, Gautier E, Müller M, Helfet DL, Wagner M. First clinical results of the locking compression plate (LCP). Injury 2003;34 Suppl 2:B43-54.
21. Burwell HN, Charnley AD. Treatment of forearm fractures in adults with particular reference to plate fixation. J Bone Joint Surg Br 1964;46:404-25.
22. Moed BR, Kellam JF, Foster RJ, Tile M, Hansen ST Jr. Immediate internal fixation of open fractures of the diaphysis of the forearm. J Bone Joint Surg Am 1986;68:1008-17.
23. Herbert DS, Gerald CW. Treatment of fractures of the radius and ulna with compression plates: A retrospective study of one hundred and nineteen fractures in seventy-eight patients. JBJS 1972;54:1167-76.
24. Chapman MW, Gordon JE, Zissimos AG. Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg Am 1989;71:159-69.
25. Teipner WA, Mast JW. Internal fixation of forearm diaphyseal fractures: Double plating versus single compression (tension band) plating – a comparative study. Orthop Clin North Am 1980;11:381-91.
26. Grace TG, Eversmann WW Jr. Forearm fractures: Treatment by rigid fixation with early motion. J Bone Joint Surg Am 1980;62:433-8.
27. Smith JE. Internal fixation in the treatment of fractures of the shafts of the radius and ulna in adults; the value of delayed operation in the prevention of non-union. J Bone Joint Surg Br 1959;41-B:122-31.
28. Sarmiento A, Cooper JS, Sinclair WF. Forearm fractures. Early functional bracing - A preliminary report. J Bone Joint Surg Am 1975;57:297-304.
29. McKee MD, Seiler JG, Jupiter JB. The application of the limited contact dynamic compression plate in the upper extremity: An analysis of 114 consecutive cases. Injury 1995;26:661-6.
30. Prakash S, Basanthi BS. Study of functional outcome of fracture forearm bones by open reduction and lc-dcp fixation. Int J Curr Pharm Clin Res 2013;3:8-12.
31. Naik SR, Gunnaiah KG. Functional outcome of surgical management of fracture both bones forearm in adults using LC-DCP. J Evol Med Dent Sci 2014;3:11134-45.
32. Muralidhar BM, Ravi KB, Madhusudan H. Surgical management of fracture both bone forearm in adult using limited contact dynamic compression plate. Int J Orthop Sci 2017;3:852-6.
33. Azboy I, Demirtas A, Uçar BY, Bulut M, Alemdar C, Ozkul E, et al. Effectiveness of locking versus dynamic compression plates for diaphyseal forearm fractures. Orthopedics 2013;36:e917-22.
34. Niemeyer P, Südkamp NP. Principles and clinical application of the locking compression plate (LCP). Acta Chir Orthop Traumatol Cech 2006;73:221-8.
35. Sommer C, Babst R, Müller M, Hanson B. Locking compression plate loosening and plate breakage: A report of four cases. J Orthop Trauma 2004;18:571-7.
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.