Forearm Plate Fixation: Should Plates Be Removed?

Document Type : RESEARCH PAPER

Authors

1 1 Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA 2 Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand

2 Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA

3 Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands

Abstract

Background: Refracture after both bone forearm fracture fixation may vary with or without plate removal. We tested
the null hypothesis that there is no difference in the rate of refracture in patients who have undergone open reduction
and internal fixation of a diaphyseal forearm bone who have retained implants versus removed implants. We also
studied factors associated with plate removal.
Methods: We retrospectively identified 645 adult patients with a total of 925 primary fractures that underwent primary
plate fixation of an ulnar or radial shaft fracture between 2002 and 2015 at a single institutional system. Patients with
nonunion, pathological fracture or infection were excluded. Independent factors associated with refracture and plate
removal were identified using multivariable analysis.
Results: Refractures occurred in 6.3% of the fractures that had forearm implant removal, compared to 2.1% of the
fractures with retained plates. Refractures were independently associated with plate removal (OR: 3.7, 95% CI: 1.2-
11.7, P=0.023) and was more frequent in the radius (OR: 2.4, 95% CI: 1.0-5.8, P=0.06). A refracture after implant
removal occurred within 3 months after removal. Ulnar plates were removed more often compared to radial plates (OR:
2.6, 95% CI: 1.4-4.7, P=0.002) as were plates used for type A fractures compared to type C fractures (OR: 3.2, 95%
CI: 1.1-9.2, P=0.032).
Conclusion: The rate of refracture is higher after plate removal compared to patients who did not have plates removed.
Although uncommon, refractures of the radius tend to be more common than a refracture of the ulna. If the implant is
symptomatic on the ulnar side, it may be preferable to remove the ulnar implant and retain the radius implant rather
than remove both plates when possible. Furthermore, limiting strenuous activity for three months after implant removal
is a consideration.
Level of evidence: III

Keywords

References

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The Archives of Bone and Joint Surgery
Volume 10, Issue 2
February 2022
Pages 153-159

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History

  • Receive Date: 26 January 2020
  • Revise Date: 13 July 2021
  • Accept Date: 03 August 2021

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