Forearm Plate Fixation: Should Plates Be Removed?
Niek Wolvetang, MD1; Jonathan Lans, MD1; Eric Walbeehm, MD2; Neal C Chen, MD3;
1Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 2Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, Netherlands, 3Massachusetts General Hospital, Boston, MA
Background: Refracture after both bone forearm fracture fixation is not well defined and may vary with or without plate removal. The aim of this study was to evaluate refracture rates after implant removal compared to those with retained implants in patients with surgically treated forearm fractures, along with the time to refracture.
Material and methods: We retrospectively reviewed the records of 657 adult patients with 923 fractures that underwent primary plate fixation of an ulnar or radial shaft fracture between 2002 and 2015 at a single institutional system in the Northeastern United States. Patients with nonunion, pathological fracture or infection were excluded. Plate removal and fracture location were evaluated for their association with refracture.
Results: Refractures occurred in 5.7% of the patients that had forearm plate removal, compared to 1.9% of the patients with retained plates. A refracture after implant removal occurred <1.9 months after removal at the site of the screw hole in all patients. Refractures in patients with retained plates occurred 17 times. Refractures occurred more often in the radial shaft compared to the ulnar shaft.
Conclusion: Although uncommon, refracture of the radius is more common than refracture of the ulna after hardware removal. If hardware is symptomatic, it may be preferable to remove ulnar hardware and retain radius hardware rather than remove both plates when possible.
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