Internal Fixation of Diaphyseal Fractures of the Forearm: A Retrospective Comparison of Hybrid Fixation Versus Dual Plating

OBJECTIVES:To compare open reduction and internal fixation using dual plating to a hybrid fixation construct with intramedullary nailing of the ulna and plate fixation of the radius in both-bone forearm fractures. DESIGN:Retrospective comparison study. SETTING:Level I trauma center. PATIENTS:A total of 56 skeletally mature individuals treated surgically for acute both-bone forearm fractures between July 2005 and December 2009. Monteggia, Galeazzi, and pathologic fractures, patients treated with external fixation and patients with traumatic brain injuries were excluded. INTERVENTION:Twenty-seven patients were treated with dual plate fixation, and 29 patients were treated using a hybrid fixation construct. MAIN OUTCOME MEASURES:Time to union, range of motion as assessed using a Grace and Eversmann score, and presence of complications. RESULTS:There was no significant difference in either time to union or Grace and Eversmann scores between the 2 groups. There was 1 nonunion in each of the 2 groups. Nine overall complications, outside nonunions, were reported5 in the dual plating group and 4 in the hybrid fixation group. CONCLUSIONS:Hybrid fixation, using open reduction and internal fixation with a plate-and-screw construct on the radius and closed—or minimally open—reduction and interlocked intramedullary fixation of the ulna, is an acceptable method for treating both-bone diaphyseal forearm fractures in skeletally mature patients. LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.