Management of Diaphyseal Forearm Fractures Using LCP Angle- Stable Fixation Devices and Intramedullary Nailing

Česká verzia

Authors: P. Višňa; Martin Vlček ; M. Valcha; E. Beitl; E. Jaganjac; Z. Šmídl
Authors place of work: I. ortopedická klinika 1. LF UK a FN Motol, Praha, přednosta kliniky: prof. MUDr. Antonín Sosna, DrSc.
Published in the journal: Rozhl. Chir., 2009, roč. 88, č. 12, s. 708-715.
Category: Monothematic special - Original

Summary

Aim of the Study:
The aim of this study is to assess treatment outcomes of diaphyseal radial and ulnar fractures using angle- stable LCP device (Synthes, Švýcarsko), compared to ForeSight intramedullary nailing (Smith&Nephew, USA).

Material and Methods:
The prospective study included 80 patients with 115 forearm fractures, assigned to two equal groups, based on the fixation method. The group included 53 males and 27 females, the mean age was 36.6 years of age (range 18–77). the mean folow up period was 18 months (range 12–32 months). The patients were repetitevely x-rayed and their functional assessment was performed at the same time. Furthermore, treatment- related complications were also evaluated.

Results:
Two cases of prolonged healing were recorded in the LCP device treatment group. Four cases of prolonged healing were recorded in the intramedullary nailing group, which healed within 18 months and did not require reoperation. The mean fracture healing time was 20.5 weeks (range 9–80 weeks) in the group with intramedullary nailing, and 19.0 weeks (range 12–46 weeks) in the LCP group. No significat differences in surgery time, healing time, postoperative pain scores or final 1-year functional outcomes were detected between the both treatment groups. Statistically significant prolonged healing was demonstrated in the intramedullary nailing group in cases, where fragment dislocation exceeded 3 mm, compared to a group of patients with anatomical repositioning and dislocation of less than 2 mm (p = 0.015; Anova). No cases of deep infections were recorded. Complications, recorded in the intramedullary nailing group, included the following: partial migration of securing nails in two subjects and incomplete synostosis in two subjects. Complications, recorded in the LCP device group, included: early re-fracturing in the original fracture location in a single subject (3 weeks after extraction).

Discussion:
The results correspond with outcomes of other recent studies. Although open repositioning and internal fixation is considered a standard treatment method in forearm diaphyseal fractures, recently changing opinion on the use of nails in this indication is apparent. Considering ongoing improvements of these implants, the trend of nailing should be more widely accepted.

Conclusion:
Although their concept of fracture fixation is different, the both implants appear indicated for the management of forearm diaphyseal fractures.

Key words:
diaphyseal forearm fractures – secured intramedullary nailing – ForeSight system – angle-stable fixation device

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