Plate or intramedullary fixation: A comparative analysis of surgical treatment options for adult both-bone forearm fracture – A retrospective clinical study

Abstract

BACKGROUND: Both-bone forearm fractures (BBFx) are common, high-energy injuries that significantly disrupt the anatomical and functional integrity of the forearm. While plate-screw osteosynthesis (PSO) has long been the standard treatment, intramedullary nailing (IMN) and hybrid methods combining both approaches have gained attention due to their potential advantages in minimally invasive procedures and functional outcomes. This study aims to compare the surgical and clinical outcomes of four different treatment strategies for BBFx. METHODS: A retrospective review was conducted on 191 adult patients who underwent surgical treatment for combined radius and ulna fractures between 2012 and 2022. Patients were divided into four groups: PSO for both radius and ulna (Group A), IMN for both bones (Group B), IMN for radius, and PSO for ulna (Group C), and PSO for radius and IMN for ulna (Group D). Surgical outcomes including union time, fluoroscopy exposure, surgical duration, and functional recovery were analyzed. RESULTS: Group B demonstrated significantly shorter surgical times (75.4 minutes) and faster fracture union (10.1 weeks) compared to Group A, which had a mean union time of 13.2 weeks. Fluoroscopy exposure was significantly lower in Group A, while Groups C and D showed intermediate results. Functional outcomes, including range of motion, grip strength, pinch strength, and QuickDASH (Quick Disabilities of the Arm, Shoulder, and Hand) scores, did not differ significantly between groups. The complication rate was lowest in Groups C and D (2.5%) and highest in Group B (6.5%), with complications such as infection and nonunion observed. CONCLUSION: While PSO remains the gold standard for BBFx, hybrid methods combining PSO and IMN provide a promising alternative, offering shorter surgical times, faster union, and reduced fluoroscopy exposure. The hybrid technique may become a preferred approach due to these advantages, although further prospective studies are required to confirm these findings. © 2025 Elsevier B.V., All rights reserved.