An Evaluation Of The Clinical Curative Efficacy Of Plate Versus Intramedullary Nail In The Treatment Of Adult Diaphyseal Forearm Fractures

Objective: Although there are many studies on the treatment of the shaft fractures of ulna and radius with intramedullary nail and plate,the research is relatively rare on the clinical efficacy of intramedullary nail and plate in treating adult fracture of the shaft of radius and ulna.This study retrospectively analyzes the clinical effects of intramedullary nail and plate in the treatment of adult fractures of the shaft of radius and ulna,thus providing a reference for the clinical selection of treatment methods for different types of the shaft fractures of ulna and radius.Methods: The study is a retrospective analysis of the clinical efficacy of the treatment of adult fractures of the shaft of radius and ulna with intramedullary nail and plate.It has collected patients with ulnar and radial shaft fractures from July 2012 to July 2016 in our hospital,documented the basic information of the patients: gender,age,type of fracture,injury mechanism,diagnosis,presence of other injuries,and General status etc.and recorded the basic information about the patients’ surgery information:distance from injury to surgery,the operation time,the surgical method,the length of the surgical incision,the length of the hospital stay,postoperative complications etc.and follow-up and recording the healing of the fractures and recovery of forearm function.It evaluates the excellent percentage according to the grading criteria of Grace and Eversman by employing statistical software SPSS20.0 in data analysis and processing.Results: A total of 76 cases have been included in the study with 3 cases failed to follow up.In accordance with the AO classification criteria of ulnar and radius shaft fractures,of the 73 patients aged(37.9±12.7)years averagely,47 are type A fractures,15 are type B fractures,and 11 are type C fractures.The mean operation time is(83.1±16.9min)in the intramedullary group and(93.3 ± 15.1min)in the plate group.The comparison of the differences between the two groups bears statistical significance(P<0.05).Mean length of hospital stay in the intramedullary group was(8.9±2.0 days)and(10.5±3.2 days)in the plate group.The comparison of the differences between the two groups bears no statistical significance(P>0.05).The mean surgical incision length in the intramedullary group was(3.0 ± 1.1cm)and(9.7 ± 2.6cm)in the plate group.The comparison of the differences between the two groups bears statistical significance(P<0.05).There are 2 cases of postoperative complications in the intramedullary group:one case of nonunion of forearm fractures(type B fracture)and one case of nonunion of ulna fracture(type C fracture),having a postoperative complications incidence of 12.5%.There are 4 cases of postoperative complications in the plate group: 1 case of non-union of radius fracture(type B fracture)and 2 cases of non-union of ulna fracture(type B fracture)and 1 case of nonunion complicated by osteomyelitis of radius fracture(type C fracture),having a postoperative complications incidence of 7.0%.The incidence of postoperative complications in the intramedullary group is slightly higher than that in the plate group,which can be attributed to the small sample size of the intramedullary group.According to Grace and Eversman Grading: 12 cases in the intramedullary group(7 typeA cases,2 typeB cases,3 typeC cases)are excellent,with 1 case(typeB fractures)being good,1 case(typeB fractures)being medium,and 2 cases being poor(1 case of typeB fracture and 1 case of type C fracture).The overall excellent and good percentage is 81.3%,with 46 cases from the plate group(38 cases of type A fractures,5 cases of type B fractures,and 3 cases of type C fractures)being excellent,2 cases(type A fractures)being good,3 cases(type C fractures)being medium,and 6 cases(5 cases of type B fractures,1 cases of type C fractures)being poor.The overall excellent and good rating was 84.2%.There is no significant difference between the two groups in type A fractures(P>0.05).With regard to type A fractures,the comparison of the differences between the two groups bears no statistical significance(P>0.05).Concerning type B fractures,the comparison of the differences between the two groups bears no statistical significance(P>0.05).And regarding type C fractures,the comparison of the differences between the two groups bears no statistical significance(P>0.05).The logistic regression analysis of the fractures(type A fractures,type B fractures,type C fractures)of the two groups shows that the comparison of the differences between the choices of the two Surgical method bears no statistical significance(P>0.05).Conclusion:1.Forearm intramedullary nail and plate treatment of adult ulnar and radius shaft fractures had no significant difference in postoperative recovery of forearm function.2.Intramedullary nail treatment of adult ulnar radius diaphyseal fractures has the advantages of small incisions,less trauma,and aesthetic appearance after surgery compared to the plate.Of course,this conclusion still requires further verification with more rational designs,larger sample size,and multicenter randomized controlled trials.