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

Sep 30, 2026

Both-bone forearm fractures (BBFx) are common high-energy injuries that compromise forearm anatomy and function. This retrospective clinical study compares four surgical strategies in 191 adults treated from 2012 to 2022: plate-screw osteosynthesis (PSO), intramedullary nailing (IMN), and two hybrid combinations. Outcomes include union time, fluoroscopy exposure, operative duration, and functional recovery. The IMN group showed shorter surgery and faster union, while PSO had lower fluoroscopy exposure. Function and complication profiles differed across groups, supporting hybrid fixation as a promising alternative.

LanguageEnglish

CategoryHealthcare

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Pages8

Reading Time20 min

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Abstract

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ORIGINAL ARTICLE Plate or intramedullary fixation: A comparative analysis of surgical treatment options for adult both-bone forearm fracture –A retrospective clinical study Muhammed Enes Karatas,1 Nazım Canberk Kiliç,2 Engin Eceviz,2 Güray Altun3 1Department of Orthopaedics and Traumatology, Istanbul Medeniyet University, Goztepe Prof. Dr.Suleyman Yalcın City Hospital,İstanbul-Türkiye 2Department of Orthopaedics and Traumatology, Kartal City Hospital, İstanbul-Türkiye 3Ortadoğu Hospital, Adana-Türkiye 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 Cand 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. Keywords: Both-bone forearm fracture; plate-screw osteosynthesis; intramedullary nailing; hybrid fixation; trauma. INTRODUCTION Both-bone forearm fracture (BBFx) are orthopedic injuries that frequently occur following high-energy injuries and have shown an increasing incidence in recent years. These types of fractures severely disrupt the anatomical and functional integrity of the forearm, leading to dynamic instability between the wrist and elbow. The ideal treatment method should help patients regain functional mobility as quickly as possible, minimize the risk of complications, and ensure satisfactory long- Cite this article as: Karatas ME, Kiliç NC, Eceviz E, Altun G. Plate or intramedullary fixation: A comparative analysis of surgical treatment options for adult both-bone forearm fracture –A retrospective clinical study. Ulus Travma Acil Cerrahi Derg 2025;31:1018-1025. Address for correspondence: Muhammed Enes Karatas Department of Orthopaedics and Traumatology, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcın City Hospital, İstanbul, Türkiye [E-mail: menskrts@hotmail.com](E-mail: menskrts@hotmail.com) Ulus Travma Acil Cerrahi Derg 2025;31(10):1018-1025 DOI: 10.14744/tjtes.2025.73928 Submitted: 10.06.2025 Revised: 18.06.2025 Accepted: 25.07.2025 Published: 07.10.2025 OPEN ACCESS This is an open access article under the CC BY-NC license ([http://creativecommons.org/licenses/by-n

FAQs

What treatment strategies were compared for adult both-bone forearm fractures?

The study compared four approaches: PSO for both radius and ulna (Group A), IMN for both bones (Group B), IMN for radius with PSO for ulna (Group C), and PSO for radius with IMN for ulna (Group D).

Which group had the fastest fracture union and shortest surgical time?

Group B (IMN for both bones) had significantly shorter surgical time (75.4 minutes) and faster union (10.1 weeks) compared with Group A.

Did functional outcomes differ significantly between groups?

No. Range of motion, grip strength, pinch strength, and QuickDASH scores did not differ significantly across groups.

Sep 30, 2026

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