- Assessment of Reduction:
- amount of radial bow is determined by drawing a line from the biciptial tuberosity to the ulnar aspect of the distal radius;
- at the point of maximal radial bow, measure the distance of a line drawn perpendicular to the first line;
- Frx Malunion:
- corrective osteotomy may be indicated for a combination of the following situations;
- loss of motion;
- proximal RU joint arthrosis;
- distal RU joint instability;
- symptoms which appear in the first year following surgery;
- malalignment:
- its essential to preservation interosseous space;
- any deviation of radius and ulna toward each other will encroach on the interosseous space;
- result is narrowing or obliteration of interosseous space, & marked restriction or loss of rotation of the forearm;
- overreduction (increasing radial bow) is also associated w/ poor results;
- 10-deg angulatory deformity results in 18% loss of pronation-supination, & 15-deg angulatory deformity resulted in 27% loss of forearm rotation;
- angulation > 20 deg, or any rotational deformity, significantly impaired forearm rotation;
- deformity at mid-shaft is more limiting than distal forearm deformity;
- references:
- The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults.
- The effect on supination-pronation of angular malalignment of fractures of both bones of the forearm.
- Non Union:
- Ununited Diaphyseal Forearm Fractures with Segmental Defects: Plate Fixation and Autogenous Cancellous Bone-Grafting.
- Double-barrel free fibula flap for treatment of infected nonunion of both forearm bones.
- Plate Removal:
- refracture may occur thru unhealed frx site if plate is removed prematurely;
- plates should be retained for at least 18-21 months to allow bone density to return to its prefrx level before removal of plates;
- forearm should be protected for six weeks following removal;
- risk factors for frx:
- frx w/ initial comminution;
- plating w/ 4.5-mm DCP;
- early plate removal;
- references:
- Refracture of bones of the forearm after plate removal.
- Refracture of bones of the forearm after the removal of compression plates
- Year Book: Refractures After Forearm Plate Removal.
Cross-union complicating fracture of the forearm. Part I: Adults.