Forearm Plate Fixation: Should Plates Be Removed?

Abstract

Background: Refracture after both bone forearm fracture fixation may vary with or without plate removal. We testedthe null hypothesis that there is no difference in the rate of refracture in patients who have undergone open reductionand internal fixation of a diaphyseal forearm bone who have retained implants versus removed implants. We alsostudied factors associated with plate removal.Methods: We retrospectively identified 645 adult patients with a total of 925 primary fractures that underwent primaryplate fixation of an ulnar or radial shaft fracture between 2002 and 2015 at a single institutional system. Patients withnonunion, pathological fracture or infection were excluded. Independent factors associated with refracture and plateremoval were identified using multivariable analysis.Results: Refractures occurred in 6.3% of the fractures that had forearm implant removal, compared to 2.1% of thefractures 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 implantremoval 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 issymptomatic on the ulnar side, it may be preferable to remove the ulnar implant and retain the radius implant ratherthan remove both plates when possible. Furthermore, limiting strenuous activity for three months after implant removalis a consideration.Level of evidence: III