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Outcomes Following Plate Fixation of Fractures of Both Bones of the Forearm in Adults
Kurt P. Droll, MD, FRCS(C)1; Philip Perna, MD1; Jeff Potter, BSc1; Elaine Harniman, BSc(PT)1; Emil H. Schemitsch, MD, FRCS(C)1; Michael D. McKee, MD, FRCS(C)1
1 St. Michael's Hospital, 55 Queen Street East, Suite 800, Toronto, ON M5C 1R6, Canada. E-mail address for M.D. McKee: mckeem@smh.toronto.on.ca
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Two commercial entities (St. Michael's Hospital and the University of Toronto) paid or directed in any one year, or agreed to pay or direct, benefits of less than $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
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Investigation performed at St. Michael's Hospital, Toronto, Ontario, Canada

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2007 Dec 01;89(12):2619-2624. doi: 10.2106/JBJS.F.01065
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Background: Internal fixation of diaphyseal forearm fractures has been associated with high union rates and satisfactory forearm motion. The purpose of this study was to investigate patient-based functional outcomes and to objectively measure strength following plate fixation of fractures of both bones of the forearm.

Methods: Range of motion, quantitative strength measurements, and validated outcome measures—i.e., DASH (Disabilities of the Arm, Shoulder and Hand) and SF-36 (Short Form-36) scores—were assessed in a cohort of thirty patients (nineteen men and eleven women with a mean age of 43.9 years) treated with plate fixation for fractures of both bones of the forearm. The mean duration of follow-up was 5.4 years, and standardized radiographs of the forearm were evaluated. Univariate and multivariate analyses were performed to identify determinants of the DASH and SF-36 Physical and Mental Component Summary (PCS and MCS) scores.

Results: Compared with the uninjured arms, the injured arms had reduced strength of forearm pronation (70% of that of the normal arm, p < 0.0001), forearm supination (68%, p < 0.0001), wrist flexion (84%, p = 0.0011), wrist extension (63%, p < 0.0001), and grip (75%, p < 0.0001). In addition, the injured arms had a significantly reduced active range of forearm supination (90% of that of the uninjured arm, p = 0.0001), forearm pronation (91%, p = 0.0028), and wrist flexion (82%, p < 0.0001). The mean DASH score (18.6 points; range, 0 to 61 points) was significantly higher than the normative value in the United States (p = 0.02). Limitations in strength correlated with worse DASH and SF-36 PCS scores. Pain and a work-related injury were independent determinants of the DASH score.

Conclusions: Stabilization with internal plate fixation following fracture of both bones of the forearm restores nearly normal anatomy and motion. However, a moderate reduction in the strength of the forearm, the wrist, and grip should be expected following this injury. Perceived disability as measured with the DASH and SF-36 questionnaires is determined by pain more than by objective physical impairment.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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