ISSN: 2640-7949
Open Journal of Trauma
Research Article       Open Access      Peer-Reviewed

The Surgical Outcomes of Diaphyseal Fractures of Radius and Ulna treated by Plate and Screws Fixation in Vietnam

Dung Tran Trung1,2*, Khanh Trinh Le2, Tuyen Nguyen Trung1, Binh Nguyen Duc1, Lam Tran Quoc2, Manh Nguyen Huu2, Phuong Nguyen Huy1,2, Nam Vu Tu1,2 and Hieu Pham Trung1,2

1Department of Orthopaedic Surgery, Saint Paul Hospital, Ha Noi, Vietnam
2Hanoi Medical University, Vietnam
*Corresponding author: Dung Tran Trung, Hanoi Medical University, No1, Ton That Tung Street, Hanoi, Vietnam, Tel: +84-24-238523798; Fax: +86-24- 38523798; E-mail: [email protected]
DOI: 10.17352/ojt.000013
Received: 16 October, 2017 | Accepted: 08 November, 2017 | Published: 09 November, 2017
Keywords: Both bones forearm fractures; Radius and ulna fractures; Plate and screws fixation

Cite this as

Trung DT, Le KT, Trung TN, Duc BN, Quoc LT, et al. (2017) The Surgical Outcomes of Diaphyseal Fractures of Radius and Ulna treated by Plate and Screws Fixation in Vietnam. Open J Trauma 1(3): 066-068. DOI: 10.17352/ojt.000013

Objectives: 1) Study the clinical and radiographic characteristics of both bones forearm fractures in adults. 2) Evaluate the surgical outcomes of plate and screws fixation for these fractures.

Material and methods: This retrospective study included 66 cases of both bones forearm fractures who were treated by open reduction and internal fixation (ORIF) with plate and screws at Viet Duc Hospital and Hanoi Medical University Hospital between January 2010 and June 2013.

Results: The average age of the patients was 34.73 ± 13.54; the ratio of men to women was 2.5/1; Traffic accident was the major mechanism of injury; fractures of middle third of radius and ulna were the most common, accounting for 48.49% of cases. Fractures in left-side were more than right. The surgical outcomes were excellent in 75.8% of cases, satisfactory in 18.2% and unsatisfactory in 6%. There were no failures.

Conclusion: Plate and screws fixation of both bones forearm fractures had good results.

Introduction

Both bones forearm shaft fractures are common orthopedic injuries [1]. These fractures do not include the Galeazzi and Monteggia fractures-dislocations.

The function of the forearm is very important, especially pronation and supination. These movements are directly involved to the precise movements of the hand. To ensure this function, in addition to the soft tissues such as muscles and nerves, the anatomical relationship of the radius and ulna plays an important role. In both bones forearm fractures, the displacement is often complicated due to the forces of the attached muscles [1,2].

Previously, conservative treatment using closed reduction and casting was the most common method for these fractures. However, as a result of difficulty in restoring the natural anatomy of radius and ulna, restoration of function remained limited [3]. Therefore, the current trend of early surgical intervention is more and more popular.

The aims of this paper:

1) Study the clinical and radiographic characteristics of both bones forearm fractures in adults.

2) Evaluate the surgical outcomes of plate and screws fixation for these fractures.

Material and Methods

This retrospective study included 66 cases of both bones forearm shaft fractures who were treated by open reduction and internal fixation (ORIF) with plate and screws at Viet Duc Hospital and Hanoi Medical University Hospital between January 2010 and June 2013.

The inclusion criteria were age of 15 years or older, non-pathological fracture, having a full medical record. The exclusion criteria were open fractures, pathological fractures, both bones forearm fractures were treated by another technique.

The Anderson forearm fractures outcome classification (Table 1) was used to determine the final outcome [4].

Table 1: Anderson forearm fractures outcome classification.
Result Criteria
Excellent Fracture union
Loss of flexion/extension of <100
Loss of pronation/supination of < 250
Satisfactory Fracture union
Loss of flexion/extension of <200
Loss of pronation/supination of < 550
Unsatisfactory Fracture union
Loss of flexion/extension of >200
Loss of pronation/supination of >500
Failure Fracture non-union
Unresolved chronic osteomyelitis

Statistical analysis was performed using SPSS Version 16.6.

Ethical issues in research: All patients have consented to use their medical information for scientific research and we ensure that their personal information will be kept confidential.

Results

There were 47 (71.21%) men and 19 (28.79%) women. The average age of the patients was 34.73 ± 13.54, most of the patients were of working age (Table 2). The mechanism of injury was a traffic accident in 37 cases (%), a fall in 18 (%), occupational accident in 5 (%), and sport accident in 6 cases (%) (Figure 1).

Table 2: Age and gender distribution.
Age 15-17 18-50 51-60 61-70 >70 Total %
Male 13 28 2 3 1 47 71.21
Female 2 6 6 1 4 19 28.79
Total 15 34 8 4 5 66 100
% 22.73 51.52 12.12 6.06 7.58 100  
Figure 1: The mechanism of injury.

There were 49 (72.24%) left and 17 (25.76%) right side fractures. Fractures of proximal, middle and distal third of forearm were 4 (6.06%), 32 (48.49%) and 17 (25.76%), respectively. Thirteen fractures (19.69%) were not at the same level (Table 3).

Table 3: The level of the fractures.
Level Proximal third Middle third Distal third Not at the same level Total
N 4 32 17 13 66
% 6.06 48.49 25.76 19.69 100

Time between the injury and the surgery is shown in (Table 4). Of the 66 patients in this study, 25 (37.88%) were operated within the first day, 21 (31.81%) were operated between day 2 and 7, 13 (19.70%) between day 8 and 30 and 7 (10.61%) between day 31 and 35 after the injury.

Table 4: Time between the injury and the surgery.
Time £ 1 day 2-7 days 8-30 days 31-35 days
N 25 21 13 7
% 37.88 31.81 19.70 10.61

These were six (9.09%) cases of superficial incisional surgical site infection, the others (90.91%) had good incision healings. Postoperative x-rays showed good results in 59 (89.39%) and minimal displacement (not perfect reduction with less than the cortical thickness of displacement) in 7 (10.61%) cases. There were no cases of significant displacement (Table 5).

Table 5: Early postoperative results.
  Results N %
Incision healing Good 60 90.91
Superficial infection 6 9.09
  Good 59 89.39
Postoperative X-rays Minimal displacement 7 10.61
  Significant displacement 0 0

The surgical outcomes according to Anderson classification are shown in (Table 6). It was found that 50 (75.76%) of patients had excellent results, 12 (18.18%) had satisfactory results and 4 (6.06%) had unsatisfactory results. There were no failures.

Table 6: Surgical outcomes according to Anderson classification.
Results Excellent Satisfactory Unsatisfactory Failure Total
N 50 12 4 0 66
% 75.76 18.18 6.06 0 100

Discussion

The mean age of the patients in our study was 34.73 ± 13.54. Patients in the working age group (15-50) accounted for the highest rate (51.25%). This is consistent with the finding of Chapman and Hertel. The average age in their studies were 33 and 38 years, respectively [8,9]. The ratio of men to women was 2.5/1, it is equivalent to that in Chapman’s study (men to women ratio of 2.7/1) [8]. Traffic accident was the most common injury mechanism (Figure 1). Similar to Garland D.E [7], injury in left side was more than right side. The reason is that most people are right-handed, so the left hand is less responsive when in an accident, therefore is at higher risk of fracture. In this study, the incidence of the left hand injuries was nearly three times more than the right hand (Figure 2).

Figure 2: The ratio of the right and left injuried forearms.

Fractures of the middle and distal third of the forearm were the most common (48.49% and 25.76%, respectively). Thirteen fractures (19.69%) were not at the same level (Table 3). Chapman also reported in his study that the typical pattern was middle third fractures [8].

All patients were operated on between day 1 and 35 after the injury. In 46 patients (69.69%) who were operated within the first week, 25 patients (37.88%) were operated on the first day (Table 4), all of these patients were operated at Hanoi Medical University Hospital. Twenty-one patients (31.81%) were operated on between day 2 and 7, and 13 patients (19.69%) were operated on between day 7 and 30 (Table 4). Interventions after 7 days were usually due to delayed hospitalization, after failure of conservative treatment or other methods. Chapman noted that the first week after the injury is the appropriate time to operate in the fractures of forearm, with nearly 90% of patients were received surgical intervention within this time in his study [8].

There were 60 cases (90.91%) of good incision healing, 6 cases (9.09%) of superficial incisional surgical site infection but they were completely cured with antibiotic treatment (Table 5). The union rate was 100%. Among them, 60 cases had good anatomical alignment and 6 cases had a minimal displacement (less than the thickness of a cortex). There were no cases of nonunion (Table 5). Thus, our results were similar to those of other authors such as Anderson LD [4], Haas N [5], Hadden WA [6], Garland D.E [7], Chapman M.W [8] and Hertel R [9].

The results in Table 6 show that 75.8% achieved excellent results, 18.2% satisfactory and 6% unsatisfactory. The unsatisfactory cases were mainly due to a complicated fracture with a severe soft tissues injury. Our results were consistent with the finding of some other authors (Table 7).

Table 7: Compare our results with some other authors.
First Author Patients
(n)		 Age (yr)
Mean (range)		 Open fractures
(n)		 Implant Healed Infection Nerve injury Result
(Anderson)
Our study 66 35 0 Plate screws 100% 9% 0 E or S: 94%
Anderson4 244   15 4.5mm DCP 97% 3% 2% E or S: 85%
Chapman8 88 33 (13-79) 33 3.5mm DCP 97% 2% 1% E or S: 91%
Hertel9 131 38 (16-63) 22 3.5mm DCP 96% 1% 0  
Leung10-14 47   19 3.5 LC-DCP 100% 2% 5% E or S: 100%

Conclusion

Both bones forearm fractures are common in men of working age. The major mechanism of these fractures is traffic accident. Fractures of the middle third are most common and fractures in left-side are more than right.

In this study, the surgical outcomes were excellent in 75.8% of cases, satisfactory in 18.2% and unsatisfactory in 6%. There were no failures.

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© 2017 Trung DT, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 

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