A comparative study of three different surgical methods for both-forearm-bone fractures in adults

The purpose of this study was to evaluate and compare the results of plate osteosynthesis, intramedullary nailing (IMN), and hybrid fixation for the treatment of both-forearm-bone shaft fractures in adults. One-hundred-one cases of both-forearm-bone shaft fractures were retrospectively reviewed. All fractures were divided into the following three groups, according to the method used for internal fixation : open reduction and internal fixation ORIF group (plate osteosynthesis), IMN group, and HYBRID group (plate osteosynthesis for the radius and intramedullary nail for the ulna). The results were assessed based on the time to union, functional recovery, restoration of the ulna and radial bow, operating time, complications, and patient satisfaction. In the ORIF, IMN, and HYBRID groups, the average union time was 10.8, 14.9, and 11.5 weeks, respectively. No intergroup differences were observed in the functional outcomes. The ORIF and HYBRID groups had a significantly better radial bow ratio compared to the IMN group. All patients in the three groups achieved union, with the exception of a single case of nonunion in the IMN group. ORIF and HYBRID fixation resulted in a more anatomical restoration of radial bow ratio, compared to the contralateral side. Such significant differences in the restoration of the radial bow had no effect on the final functional outcomes and minimal effect on forearm range of motion. Although there are statistically significant effects on the final forearm range of motion, the difference was only 5°. Thus, if the indication is properly selected, our results suggest that hybrid fixation would be acceptable and effective treatment options for both-forearm-bone fractures in adults.