Outcomes Following Plate Fixation of Fractures of Both Bones of the Forearm in Adults


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Abstract

Background:Internal fixation of diaphyseal forearm fractures has been associated with high union rates and satisfactory forearm motion. The purpose of this study was to investigate patient-based functional outcomes and to objectively measure strength following plate fixation of fractures of both bones of the forearm.Methods:Range of motion, quantitative strength measurements, and validated outcome measures-i.e., DASH (Disabilities of the Arm, Shoulder and Hand) and SF-36 (Short Form-36) scores-were assessed in a cohort of thirty patients (nineteen men and eleven women with a mean age of 43.9 years) treated with plate fixation for fractures of both bones of the forearm. The mean duration of follow-up was 5.4 years, and standardized radiographs of the forearm were evaluated. Univariate and multivariate analyses were performed to identify determinants of the DASH and SF-36 Physical and Mental Component Summary (PCS and MCS) scores.Results:Compared with the uninjured arms, the injured arms had reduced strength of forearm pronation (70% of that of the normal arm, p < 0.0001), forearm supination (68%, p < 0.0001), wrist flexion (84%, p = 0.0011), wrist extension (63%, p < 0.0001), and grip (75%, p < 0.0001). In addition, the injured arms had a significantly reduced active range of forearm supination (90% of that of the uninjured arm, p = 0.0001), forearm pronation (91%, p = 0.0028), and wrist flexion (82%, p < 0.0001). The mean DASH score (18.6 points; range, 0 to 61 points) was significantly higher than the normative value in the United States (p = 0.02). Limitations in strength correlated with worse DASH and SF-36 PCS scores. Pain and a work-related injury were independent determinants of the DASH score.Conclusions:Stabilization with internal plate fixation following fracture of both bones of the forearm restores nearly normal anatomy and motion. However, a moderate reduction in the strength of the forearm, the wrist, and grip should be expected following this injury. Perceived disability as measured with the DASH and SF-36 questionnaires is determined by pain more than by objective physical impairment.Level of Evidence:Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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