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Minimally Invasive Plate Osteosynthesis of Comminuted One Bone Fractures of Forearm Shaft

Objective: Due to rotatability of the forearm, open reduction and internal fixation with plate is a gold standard treatment of forearm fracture. Our hypothesis was that if it does not make any problems on alignment and rotation, minimally invasive plate osteosynthesis (MIPO) technique could be also applied for forearm fracture. It is easy to align when only one of forearm bone is fractured because reference point exists. The purpose of this study is to introduce MIPO technique for comminuted one bone fracture of forearm shaft. Methods: Between May 2011 and January 2014, 17 patients with fractures of forearm shaft were treated by MIPO technique. MIPO technique was applied to single forearm bone shaft fractures or to the more severe comminuted bone when both forearm bones are fractured. The other less sever bone fracture is treated with open reduction and internal fixation. There were 5 cases of forearm both bone fracture (radius 3, ulna 2), 5 cases of radius shaft fracture, and 7 cases of ulnar shaft fracture. MIPO technique was applied in total 8 cases of radius fracture and 9 cases of ulna fracture. The mean follow-up period was 26 months (range, 24-44 months). Bone union period was determined by radiographs taken upon follow up, and clinical function was evaluated by range of movement, Grace and Eversmann criteria measured at the last follow up. Results: Bony union was achieved in all patients. The mean time to bone union was 10.8 weeks in radius and 13.4 weeks in ulna. The average range of motion of forearm was 80.6° in supination and 83.2° in pronation. Both groups showed mean percentage of 97 compared with the contralateral side. Functional results assessed by Grace and Eversmann criteria were rated excellent in 11 cases and good in 6 cases. Conclusion: In our series, MIPO technique for comminuted one bone fractures in forearm shaft fracture was safe and effective, which had advantages, including a small skin incision, in bone biology.