Internal fixation of forearm diaphyseal fractures: double plating versus single compression (tension band) plating--a...

Eighty-four fresh diaphyseal fractures of the forearm in 55 patients were treated by double plates, with bone union occurring in 97.6 per cent. Seventy fresh diaphyseal fractures of the forearm in 48 patients were treated by single compression plates (tension band plates) with bone union occurring in 100 per cent. In both series, other than infection (two in the double plating series and none in the compression plating series), the major complication was synostosis. This matter is being further investigated at this time by one of the authors (JWM) in an attempt to abort this most distressing complication. The other major complication is related to the stress riser effect of the implant, particularly after hardware removal. There still remains some difference of opinion as to whether metal has to be removed, and in general, unless there is a clear-cut indication for its removal, we do not do so. We now believe that double plating and single compression plating (tension band plating) will insure a high rate of union, a generally excellent functional result, and a low complication rate. However, ASIF (AO) plating provides a somewhat shorter operative time and, at least theoretically, less stress protection of bone and possibly less devitalization of tissue because of the need for less soft tissue stripping for exposure. Therefore, in our clinic for the most part we now use single tension band plating for displaced diaphyseal fractures of the forearm in the adult.