Predictive Factors for Union Time in Adult Diaphyseal Forearm Fractures

Purpose: Although open reduction and internal fixation (ORIF) by plating are the treatment of choice for diaphyseal fractures of the forearm, delayed union and non-union remain as existing complications. This study aimed to analyze predictive factors for the union time in diaphyseal fractures of the forearm. Methods: A retrospective study was conducted on all adult patients with diaphyseal forearm fractures who underwent surgical treatment with plate fixation between 2007 and 2016 at a tertiary care referral center. The patients were divided into two groups based on their union times: <= 3 months or >3 months. They were then compared for demographics, fracture pattern and characteristics, associated injuries, type of fixation, and quality of postoperative reduction. Results: Eighty-six diaphyseal forearm bone fractures (radius, ulna, or both) were observed in 55 adults. Out of these fractures, 55 (65.1%) achieved union within <= 3 months, 26 (30.3%) took more than 3 months to achieve union, and 4 (4.6%) resulted in nonunion. The use of a locking plate in open reduction and internal fixation of diaphyseal forearm fractures significantly increased the likelihood of union within <= 3 months (p = 0.043). The parameter of gap width at the fracture site, as observed on postoperative X-rays, showed a qualitative and quantitative correlation with union time (p = 0.028). Conclusion: The use of a locking plate, combined with reducing the gap width at the fracture site after reduction during open reduction and internal fixation (ORIF) of diaphyseal forearm fractures, is significantly correlated with an increased likelihood of achieving bone union within 3 months.