A comparison of the treatment results of dpen reduction internal fixation and intramedullary nailing in adult forearm diaphyseal fractures

BACKGROUND: We compared the union and functional results of intramedullary nailing and open reduction internal fixation treatment applied to adults with a forearm diaphysis fracture (fracture of the radius and/or ulna).
METHODS: We retrospectively examined 90 patients with completed skeletal maturation who were surgically treated for a forearm diaphyseal fracture. Patients with a Monteggia Galeazzi and ipsilateral upper extremity fracture and those with an open epiphyseal line, Type 3 open fracture, pathological fracture, or brain trauma were excluded from the study. Open reduction and internal fixation (ORIF) was applied to 42 patients (plate group), and intramedullary nailing was performed in 48 patients (intramedullary nailing group). Both treatment groups were compared with respect to time to union, joint range of motion, operating time, grip strength, Grace-Eversman criteria, and complications.
RESULTS: The mean operating time was 63.29 (range, 40–100) min in the plate group and 46.02 (range, 17–85) min in the intramedullary nailing group. The mean time to union was 13.19 (range, 10–20) and 10.85 (range, 8–20) weeks, respectively. While a statistically significant difference was determined between groups with respect to operating time and time to union, no difference was determined in the Grace-Eversman evaluation criteria, forearm supination, pronation degrees, and grip strength.
CONCLUSION: The results of this study showed a significant difference in the intramedullary nailing treatment with respect to time to union, operating time, and amount of bleeding compared with the ORIF treatment. However, no difference was determined in the functional evaluation criteria. Thus, both treatment methods are acceptable in the treatment of forearm diaphyseal fractures in adults with skeletal maturation.

Yetiþkin önkol diafiz kýrýklarýnda açýk redüksiyon internal fiksasyon ve intramedüller çivi tedavi sonuçlarýnýn karþýlaþtýrýlmasý

AMAÇ: Yetiþkin önkol diafiz kýrýðý (radius, ulna veya her iki kemik kýrýðý) olan hastalarda uyguladýðýmýz intramedüller çivi tedavisi ile açýk redüksiyon internal fiksasyon tedavi yöntemlerini kaynama ve fonksiyonel sonuçlar açýsýndan karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Önkol diafiz kýrýðý nedeniyle cerrahi tedavi uyguladýðýmýz, iskelet sistemi matürasyonu tamamlanmýþ 90 hastayý geriye dönük olarak inceledik. Monteggia, Galeazzi, ipsilateral üst ekstremite fraktürü olan hastalar, epifiz hattý açýk hastalar, Tip 3 açýk kýrýðý olan hastalar, patolojik kýrýðý olan hastalar ve beyin travmasý olan hastalar çalýþmaya dahil edilmedi. Hastalarýn 42’sine açýk redüksiyon internal fiksasyon (plak grubu), 48’ine intramedüller çivi tedavisi (ÝM çivi grubu) uygulandý. Ýki tedavi grubu; kaynama zamaný, eklem hareket açýklýðý, ameliyat süresi, kavrama gücü, Grace-Eversman kriterleri ve komplikasyon sonuçlarýna göre karþýlaþtýrýldý.
BULGULAR: Ameliyat süresi plak grubunda 63.29 (40–100) dakika, intramedüller çivi grubunda 46.02 (17–85) dakika idi. Plak grubunda ortalama kaynama süresi 13.19 (10–20) hafta, ÝM çivi grubunda ortalama 10.85 (8–20) hafta deðerlendirildi. Ýstatistiksel olarak kaynama süresi ve ameliyat süreleri açýsýndan her iki grup arasýnda anlamlý fark saptanýrken Grace-Eversman deðerlendirme kriterleri, önkol supinasyon, pronasyon dereceleri ve kavrama gücü açýsýndan iki grup arasýnda fark saptanmadý.
TARTIÞMA: Ýntramedüller çivi tedavisinde kaynama süresi, ameliyat süresi ve kanama miktarý açýsýndan açýk redüksiyon internal fiksasyon tedavisine göre anlamlý fark saptandý. Ancak fonksiyonel deðerlendirme kriterlerine göre fark saptanmamýþtýr. Bu nedenle iskelet sistemi matürasyonu tamamlanmýþ önkol diafiz kýrýðý olan eriþkin hastalarda her iki tedavi metodu kabul edilebilir yöntemlerdir.