Review Question - QID 4016

Definitive surgical fixation for a simple transverse both bone forearm fracture would include open reduction and internal fixation with absolute stability with direct healing by internal remodelling (i.e., primary bone healing). The radius is fixed with a 7-hole 3.5mm LC-DCP plate in compression mode. The ulna was fixed with a 8-hole 3.5mm LC-DCP neutralization plate with (2) lag screws.

Restoration of the radial bow, length, and alignment in conjunction with primary bone healing would optimize the restoration of pronation/supination in the forearm. Compression plating and anatomic reduction of articular fractures are examples of absolute stability. Casting, bridge plating, external fixation, and intramedullary nailing provide relative stability, with secondary bone healing resulting.

Moed et al. reviewed 56 patients with open diaphyseal forearm fractures treated with immediate internal fixation. The complications included deep infection in 2 patients and non-union in 6. This study indicated immediate stable plate fixation was a beneficial method of treatment for open diaphyseal forearm fractures.

Jones et al. discussed current literature on treating adult diaphyseal forearm fractures with open reduction internal fixation versus intramedullary nailing, and concluded a randomized prospective study is needed. They stated current literature is inconclusive.

Figure A shows a both bone forearm fracture fixed with absolute stability. The radius is fixed with a 7-hole 3.5mm LC-DCP plate in compression mode. The ulna was fixed with a 8-hole 3.5mm LC-DCP neutralization plate with (2) lag screws.

Incorrect Answers:
Answers 1-2, 4-5: Absolute stability is a biological process of osteonal bone remodelling. This is predominantly intramembranous ossification. Enchondral bone formation occurs in non-rigid fracture healing (secondary bone healing).