Review Question - QID 216689

This patient has a comminuted radial shaft fracture, which is best treated using principles of relative stability by bridging the fracture.

Fracture fixation principles are important to understand and apply to each case. Absolute stability is defined by a construct that stimulates primary healing with low strain and micromotion at the fracture site. An example of absolute stability is anatomic reduction and compression plating. Relative stability stimulates healing with endochondral bone formation and intermediate strain at the fracture site. Examples of relative stability include bridge plating, intramedullary nailing, casting, and external fixation. Forearm fractures can be treated with absolute or relative stability depending on the fracture pattern. If transverse and amenable to compression, absolute stability is utilized, however, with significant comminution a bridge plate and relative stability technique is more appropriate.

Wagner described general plating principles, noting that exposure and reduction were important in achieving the goal of stable fixation. They discuss the goals of primary and relative stability and the specific functions of plating as they relate to compression or bridging techniques. They importantly note that the fixation technique used is independent of the specific plate chosen and is dependent on the type of fracture being treated.

Bartonicek et al review the anatomy and biomechanics of fixing radial shaft fractures, nothing the importance of choosing the correct plate and contouring it appropriately. They feel that the 3.5mm DCP plates are equivalent to the 3.5mm LCP plates for radial shaft fixation given the flexibility of screw trajectory and better fit. They note that fractures with more comminution or segmental defects may require more screws on each side of the fracture to maintain stability.

Figure A demonstrates an AP radiograph of a comminuted radial shaft fracture with retained metallic fragments.

Incorrect Answers:
Answer 1: Open reduction and internal fixation with absolute stability is more appropriate for a transverse fracture that can be anatomically reduced and compressed using a plate.
Answer 3: Closed reduction and casting is not appropriate in most cases for adult both bone forearm fractures due to their innate instability and inability to restore proper radial bow, length and alignment.
Answer 4: Flexible intramedullary nailing of an adult both bone forearm fracture does not provide adequate stability for definitive management. They are more appropriately used for pediatric both bone forearm fractures.
Answer 5: External fixation may be used as a temporizing measure in cases with significant soft tissue compromise but would not be the best choice in this case.