Internal fixation of forearm fractures in the 1980s: lessons to be learnt

A series of 156 diaphyseal forearm fractures in 108 patients were treated by internal fixation between 1980 and 1985. These cases have been critically reviewed in the light of the present knowledge and expertise of internal fixation. A total of 122 fractures were fixed with ASIF compression plates. An analysis of results shows that 17 patients (15.7 per cent) had a poor clinical symptom result, 29 patients (26.9 per cent) had a poor functional score, 14 (13 per cent) had a poor subjective and employment score, and 40 fractures (32 per cent) united after 18 weeks. Non-union rate was 10.3 per cent, the infection rate was 5.5 per cent and there were three cases (2.7 per cent) of synostosis. Only six patients had primary cancellous bone grafting. A statistical analysis of the variables which may affect the result shows that the most important factors are accurate reduction of the fracture, correct use of interfragmentary screw fixation and rigid fixation. Failure to observe these rules will produce a poor result. Fracture complexity and comminution, especially if combined with a butterfly fragment, predispose to a poor result.