Abstract
Rigid plate osteosynthesis with compression is still the treatment of choice for forearm fractures to gain anatomic reposition, provide proper rotation and avoid a bridging callus. Due to necessary operative dissection there is a serious risk for infection and malunion. Based on good clinical results with elastic bridge plating at femur, humerus and tibia, this technique was also started to be used for forearm fractures in our clinic in 1995. In a prospective study, 86 of 124 consecutive patients at the age of 35.2 ± 14.7 years with 129 diaphyseal fractures of the radius or ulna (AO: 37 type A, 36 type B, 13 type C) were analyzed between January 1998 and December 2003. All fractures were stabilized by bridge plating. Radiographic union and clinical outcome were documented. Of the 129, 122 diaphyseal fractures (94.5%) healed within 10.2 ± 3.4 weeks without complications (no nerve lesions, nonunion, synostosis callus). One re-osteosynthesis, one secondary lag screw, and five cancellous bone grafts were necessary before final healing. About 79.1% of the patients had a perfect clinical outcome; 17.4% had additional severe injuries of the same arm. Bridge plating without interfragmentary compression is a reliable surgical procedure even for forearm fractures with low risk of infection and nonunion.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Heitemeyer U, Kemper F, Hierholzer G, Haines J. Severely comminuted femoral shaft fractures: treatment by bridgingplate osteosynthesis. Arch Orthop Trauma Surg 1987;106:327–330.
Kleining, Rhax PM. Internal bridging osteosynthesis without reposition of the fragments as an alternative method to internal fixation with anatomical reposition of multifragmentary fractures. Unfallheilkunde 1981;153:213–23.
Schmidtmann U, Knopp W, Wolff C, Stürmer KM. Results of the elastic bridge plating of the simple femoral fractures in polytrauma patients. An alternative to common surgical techniques. Unfallchirurg 1997;100:949–56.
Eijer H, Hauke C, Arens S, Printzen G, Schlegel U, Perren SM. PCFix and local infection resistance - influence of implant design on postoperative infection developement, clinical and experimental results. Injury 2001;32:B38–43.
Claudi B, Schläpfer F, Cordey J, Perren SM, Allgoewer M. Die schräge Plattenzugschraube - in-vitro-Messung der Stabilität an queren Osteotomien des Tibiaschaftes. Helv Chir Acta 1990;46:177–82.
Hertel R, Pisan M, Lambert S, Ballmer FT. Plate osteosynthesis of diaphyseal fractures of the radius and ulna. Injury 1996;27:545–8.
Mackay D, Wood L, Rangan A. The treatment of isolated ulna fractures in adults: a systematic review. Injury 2000;31:565–70.
Mueller ME, Allgoewer M, Schneider R, Willenegger H. Manual of internal fixation. Techniques recommended by the AO-ASIF group, 3rd edn. Springer, Berlin, 2003.
Oestern HJ, Tscherne H. Pathophysiology and classification of soft tissue damage in fractures. Orthopaede 1983;12:2–8.
Labosky DA, Cermak MB, Waggy CA. Forearm fracture plates: to remove or not to remove. J Hand Surg [Am] 1990;15:294–301.
Chapman MW, Gordon JE, Zissimos AG. Compression plate fixation of acute fractures of the diaphysis of the radius and ulna. J Bone J Surg [Am] 1989;71:159–69.
Deluca PA, Lindsey RW, Rowe PA. Refracture of bones of the forearm after removal of compression plates. J Bone J Surg [Am] 1988;70:1372–76.
Gunst MA, Suter C, Rahn BA. Die Knochendurchblutung nach Plattenosteosynthese. Eine Untersuchung an der intakten Kaninchentibia mit Disulfinblau-Vitalfärbung. Helv Chir Acta 1979;46:171–5.
Hughston JC. Fractures of the distal radius shaft: mistakes and management. J Bone J Surg [Am] 1957;39:249–64.
Schemitsch EH, Richards RR. The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults. J Bone J Surg [Am] 1992;68:1068–78.
Stern PJ, Drury WJ. Complication of plate fixation of forearm fractures. Clin Orthop Relat Res 1983;175:25–9.
Stuermer KM, Schuchard W. New aspects of intramedullary nailing and reaming of the shaft in long bones in animal experiments. Part III: Fracture healing, vascularization and bone remodelling. Unfallheilkunde 1980;83:433–45.
Street DN. Intramedullary forearm nailing. Clin Orthop Relat Res 1986;212:219–30.
Stuermer KM. Pathophysiolgy of the delayed fracture healing. Orthopäde 1996;25:86–393.
Lindvall EM, Sagi HC. Selective screw placement in forearm compression plating: results of 75 consecutive fractures stabilized with 4 cortices of screw fixation on either side of the fracture. J Orthop Trauma 2006;20:157–63.
Stuermer KM. Elastic plate osteosynthesis, biomechanics, indications and technique in comparison with rigid osteosynthesis. Unfallchirurg 1996;99:816–29.
Hadden WA, Reschauer R, Seggl W. Results of AO plate fixation of forearm shaft fractures in adults. Injury 1983;15:44–52.
Moore TM, Klein JP, Patzakis MJ, Harvey JP Jr. Results of compression-plating of closed Galeazzi fractures. J Bone J Surg [Am] 1985;67:1015–21.
Smith H, Sage FP. Medullary fixation of forearmfractures. J Bone J Surg [Am] 1957;39:91–8.
Aho AJ, Nieminen SJ, Salo U, Luoma R. Antebrachium fractures: rush pin fixation today in the light of late results. J Trauma 1984;24:604–10.
Schoene G. Treatment of forearm fractures with bolt. Munch Med Wochenschr 1913;60:23–7.
Sage FP. Medullary fixation of fractures of the forearm. J Bone J Surg [Am] 1959;41:1489–93.
Jubel A, Andermahr J, Isenberg J, Issavand A, Prokop A, Rehm KE. Outcomes and complications of elastic stable intramedullary nailing for forearm fractures in children. J Pediatr Orthop 2005;14:375–80.
Calder PR, Achan P, Barry M. Diaphyseal forearm fractures in children treated with intramedullary fixation: outcome of K-wire versus elastic stable intramedullary nail. Injury 2003;34:278–82.
Lascombes P, Prevot J, Ligier JN, Metaizeau JP, Poncelet T. Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases. J Pediatr Orthop 1990;10:167–71.
Van der Reis WL, Otsuka NY, Moroz P, Mah J. Intramedullary nailing versus plate fixation for unstable forearm fractures in children. J Pediatr Orthop 1998;18:9–13.
Mueller ME, Allgoewer M, Willenegger H. Manual of internal fixation. Springer, Berlin, 1969.
Garland DE, Jones RC, Kunkle RW. Upper extremity fractures in the acute spinal cord injured patient. Clin Orthop Relat Res 1988;233:110–5.
Gerber C, Mast JW, Ganz R. Biological internal fixation of fractures. Arch Orthop Trauma Surg 1990;109:295–303.
Hranilovic B, Nikolic R, Pericic D. Injuries of the radial nerve in fractures of the forearm. Acta Chir Iugosl 1977;24:281–4.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Open Access This is an open access article distributed under the terms of the Creative Commons Attribution Noncommercial License ( https://creativecommons.org/licenses/by-nc/2.0 ), which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
About this article
Cite this article
Stuermer, E.K., Sehmisch, S., Frosch, KH. et al. The Elastic Bridge Plating of the Forearm Fracture: A Prospective Study. Eur J Trauma Emerg Surg 35, 147–152 (2009). https://doi.org/10.1007/s00068-008-8002-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-008-8002-3