Effectiveness of open reduction and internal fixation for bipolar fracture-dislocation of forearm_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Weipeng ¹ ,  LI Dongsheng ¹ , WANG Aiguo ¹ , GONG Maoqi ² , ZHENG Shijun ¹ , WANG Kun ¹ , WANG Long ¹ , ZHAO Dongxiao ¹

1. Department of Upper Extremity Orthopaedics, Zhengzhou Orthopaedic Hospital, Zhengzhou Henan, 450052, P.R.China;
2. Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, 100000, P.R.China;

Corresponding author：

LI Dongsheng, Email: zzsgkyylds@sina.com

Keywords：

Forearm injury; bipolar fracture; joint dislocation; open reduction; internal fixation

DOI：

10.7507/1002-1892.202008004

Video：

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Objective To explore the effectiveness of open reduction and internal fixation for bipolar fracture-dislocation of the forearm.Methods Between June 2014 and March 2019, 14 patients with bipolar fracture-dislocation of the forearm were treated. There were 9 males and 5 females, aged from 19 to 52 years (mean, 34.9 years). There were 8 cases of falling injuries, 4 cases of traffic accident injuries, 1 case of sports injury, and 1 case of machine strangulation injury. The time from injury to admission was 2-48 hours, with an average of 16.6 hours. All patients were closed injuries. All patients were treated with open reduction and internal fixation; the upper radioulnar joints were treated with circumferential ligament repair or lateral collateral ligament repair according to the joint stability. And the patients with lower radioulnar joint instability were also treated with the TightRope plate with loop fixation. After 3 weeks of plaster fixation, the patients started functional exercises. The fracture healing time, stability and range of motion of wrist and elbow joints, and forearm rotation function were recorded. The effectiveness was evaluated by Anderson’s forearm function score at last follow-up.Results The incisions healed by first intention. All 14 cases were followed up 12-36 months with an average of 24.8 months. All fractures healed, with an average healing time of 14.9 weeks (range, 12-18 weeks). The stabilities of the upper and lower radioulnar joints restored well. At last follow-up, the elbow flexion and extension range of motion was 65°-160°, with an average of 124.6°; the wrist flexion and extension range of motion was 115°-165°, with an average of 155.0°; the forearm rotation range of motion was 65°-165°, with an average of 154.6°. According to Anderson’s forearm function score, 8 cases were excellent, 5 cases were good, and 1 case was unsatisfactory. Conclusion The treatment of bipolar fracture-dislocation of the forearm needs comprehensive consideration and individualized treatment plan. The focus is to restore the anatomical structure of the radius and ulna and firm internal fixation, stabilize the upper and lower radioulnar joints, and perform functional exercises as soon as possible after operation to obtain satisfactory effectiveness.

Citation： XU Weipeng, LI Dongsheng, WANG Aiguo, GONG Maoqi, ZHENG Shijun, WANG Kun, WANG Long, ZHAO Dongxiao. Effectiveness of open reduction and internal fixation for bipolar fracture-dislocation of forearm. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(2): 149-153. doi: 10.7507/1002-1892.202008004 Copy

1.	Odena IC. Bipolar fracture-dislocation of the forearm. J Bone Joint Surg (Am), 1952, 34(4): 968-976.
2.	Jupiter JB, Kour AK, Richards RR, et al. The floating radius in bipolar fracture-dislocation of the forearm. J Orthop Trauma, 1994, 8(2): 99-106.
3.	Najeb Y, Essadki B, Latifi M, et al. Bipolar dislocation of the forearm. Chir Main, 2007, 26(1): 62-64.
4.	Aşkar H, Ertürk C, Altay MA, et al. Bipolar dislocation of the forearm (floating forearm). Acta Orthop Traumatol Turc, 2014, 48(1): 102-105.
5.	Zejjari H, Louaste J, Chkoura M, et al. Bilateral floating forearm: a case report. Chir Main, 2011, 30(2): 155-158.
6.	公茂琪, 李国, 蒋协远, 等. 前臂双极骨折脱位的诊断与治疗. 中华创伤骨科杂志, 2018, 20(11): 953-959.
7.	Hargadon EJ, Porter ML. The Essex-Lopresti injury: a variation. J Hand Surg (Br), 1988, 13(4): 450-452.
8.	Mcdougall A, White J. Subluxation of the inferior radio-ulnar joint complicating fracture of the radial head. J Bone Joint Surg (Br), 1957, 39-B(2): 278-287.
9.	Leung YF, Ip SP, Ip WY, et al. The crisscross injury mechanism in forearm injuries. Arch Orthop Trauma Surg, 2005, 125(5): 298-303.
10.	Spicer DD, Hargreaves D, Eckersley R. Simultaneous dislocations of the radiocapitellar and distal radioulnar joints. J Orthop Trauma, 2002, 16(2): 136-138.
11.	蒋协远, 公茂琪. 积水潭医院创伤骨科治疗技术肘关节骨折. 北京: 北京科学技术出版社, 2019: 6.
12.	Broberg MA, Morrey BF. Results of treatment of fracture-dislocations of the elbow. Clin Orthop Relat Res, 1987, (216): 109-119.
13.	Parikh SN, Lykissas MG, Mehlman CT, et al. Convergent and divergent dislocation of the pediatric elbow: two case reports and comprehensive review of literature. J Pediatr Orthop B, 2014, 23(2): 158-167.
14.	McAuliffe TB, Williams D. Transverse divergent dislocation of the elbow. Injury, 1988, 19(4): 279-280.
15.	Anderson LD, Sisk D, Tooms RE, et al. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg (Am), 1975, 57(3): 287-297.
16.	Leung YF, Ip SP, Wong A, et al. Isolated dislocation of the radial head, with simultaneous dislocation of proximal and distal radio-ulnar joints without fracture in an adult patient: case report and review of the literature. Injury, 2002, 33(3): 271-273.
17.	王金锋, 吴昊, 赵诚钰, 等. 成人桡骨小头半脱位的早期诊治. 中华手外科杂志, 2014, 30(6): 467-468.
18.	孔祥如, 杨太明, 朱裕成, 等. Essex-Lopresti 损伤合并桡骨远端关节内骨折的手术治疗. 中华创伤骨科杂志, 2016, 18(4): 341-345.
19.	路博, 孔繁林, 丁亮华, 等. 数字化钢板在尺桡骨骨干骨折中的临床应用. 中国骨与关节损伤杂志, 2014, 29(5): 457-459.

1. Odena IC. Bipolar fracture-dislocation of the forearm. J Bone Joint Surg (Am), 1952, 34(4): 968-976.
2. Jupiter JB, Kour AK, Richards RR, et al. The floating radius in bipolar fracture-dislocation of the forearm. J Orthop Trauma, 1994, 8(2): 99-106.
3. Najeb Y, Essadki B, Latifi M, et al. Bipolar dislocation of the forearm. Chir Main, 2007, 26(1): 62-64.
4. Aşkar H, Ertürk C, Altay MA, et al. Bipolar dislocation of the forearm (floating forearm). Acta Orthop Traumatol Turc, 2014, 48(1): 102-105.
5. Zejjari H, Louaste J, Chkoura M, et al. Bilateral floating forearm: a case report. Chir Main, 2011, 30(2): 155-158.
6. 公茂琪, 李国, 蒋协远, 等. 前臂双极骨折脱位的诊断与治疗. 中华创伤骨科杂志, 2018, 20(11): 953-959.
7. Hargadon EJ, Porter ML. The Essex-Lopresti injury: a variation. J Hand Surg (Br), 1988, 13(4): 450-452.
8. Mcdougall A, White J. Subluxation of the inferior radio-ulnar joint complicating fracture of the radial head. J Bone Joint Surg (Br), 1957, 39-B(2): 278-287.
9. Leung YF, Ip SP, Ip WY, et al. The crisscross injury mechanism in forearm injuries. Arch Orthop Trauma Surg, 2005, 125(5): 298-303.
10. Spicer DD, Hargreaves D, Eckersley R. Simultaneous dislocations of the radiocapitellar and distal radioulnar joints. J Orthop Trauma, 2002, 16(2): 136-138.
11. 蒋协远, 公茂琪. 积水潭医院创伤骨科治疗技术肘关节骨折. 北京: 北京科学技术出版社, 2019: 6.
12. Broberg MA, Morrey BF. Results of treatment of fracture-dislocations of the elbow. Clin Orthop Relat Res, 1987, (216): 109-119.
13. Parikh SN, Lykissas MG, Mehlman CT, et al. Convergent and divergent dislocation of the pediatric elbow: two case reports and comprehensive review of literature. J Pediatr Orthop B, 2014, 23(2): 158-167.
14. McAuliffe TB, Williams D. Transverse divergent dislocation of the elbow. Injury, 1988, 19(4): 279-280.
15. Anderson LD, Sisk D, Tooms RE, et al. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg (Am), 1975, 57(3): 287-297.
16. Leung YF, Ip SP, Wong A, et al. Isolated dislocation of the radial head, with simultaneous dislocation of proximal and distal radio-ulnar joints without fracture in an adult patient: case report and review of the literature. Injury, 2002, 33(3): 271-273.
17. 王金锋, 吴昊, 赵诚钰, 等. 成人桡骨小头半脱位的早期诊治. 中华手外科杂志, 2014, 30(6): 467-468.
18. 孔祥如, 杨太明, 朱裕成, 等. Essex-Lopresti 损伤合并桡骨远端关节内骨折的手术治疗. 中华创伤骨科杂志, 2016, 18(4): 341-345.
19. 路博, 孔繁林, 丁亮华, 等. 数字化钢板在尺桡骨骨干骨折中的临床应用. 中国骨与关节损伤杂志, 2014, 29(5): 457-459.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of open reduction and internal fixation for bipolar fracture-dislocation of forearm

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