Forearm Fracture Fixation with Locking Plates: Does Size Matter?

Forearm shaft fractures of the radius and/or ulna are typically repaired with plates and screws, with 3.5 mm nonlocking screws being generally recommended. However, smaller plates and screws, either nonlocking or locking, can also be applied. The purpose of this study was to retrospectively review whether fracture healing rates and related complications are affected by plate size and type.

Patient demographic and descriptive data were retrospectively collected for all patients with a forearm shaft fracture treated with repair of the radial shaft and/or ulna shaft between 2017 and 2021 at a multiprovider and multilocation single institution. Inclusion criteria involved use of a locking plate with a minimum radiographic follow-up of 60 days and/or until fracture union was confirmed.

A total of 110 patients met inclusion criteria. There were 45 (40.9%) females and 65 (59.1%) males included with the mean age at time of injury being 47 years (± 22). There were 34 (30.1%) isolated radius fractures, 50 (45.5%) isolated ulna fractures, and 26 (23.6%) both bone forearm fractures. Screw sizes consisted of 3.5 mm (small fragment) screws in 57 (52%) cases, whereas 2.7 mm/2.5 mm/2.4 mm (mini fragment) screws were used in 53 (48%) cases. Fracture union was confirmed in 108 (98%) cases. Among the two nonunion cases, one case (50%) involved a small fragment, and one case (50%) involved a mini fragment plate.

This study confirms that fracture union is high following any size plate fixation of radius and/or ulna fractures. Moreover, smaller screw sizes did not affect fracture union rates. Choice of plate type and screw diameter should be based on patient characteristics and surgeon preference and need not be limited to only 3.5 mm plate and screws.

Prognosis IIb.