Clinical results of minimal screw plate fixation of forearm fractures

Traditional plating technique for forearm fractures specifies implant selection based on achieving a minimum number of "cortices" of screw fixation on either side of the fracture. Recent biomechanical data suggest that plates with fewer screws provide equivalent strength of fixation compared with standard compression plating techniques in forearm fractures. As described in this article, we retrospectively reviewed a surgeon's experience at a regional level I trauma center to evaluate the clinical outcome of this newer fixation strategy. Seventy-eight fractured bones were plated using "minimal" screw technique--less than the traditionally recommended 6 cortices of screw purchase. Nonunion or fixation failure occurred in 7 fractures (5 patients), producing a union rate of 91% (71/78). All nonunions were atrophic and occurred in open fractures with bone loss. No construct failed because of fixation loss caused by having too few screws. Minimal screw plate technique was stable fixation, despite not having 6 cortices on both sides of the fracture. Technical emphasis should be on adequate plate length rather than number of cortices of fixation in each segment.