Acta clin Croat 2000; 39:147-153 Professional Paper 147 FOREARM SHAFT FRACTURES: RESULTS OF TEN-YEAR FOLLOW-UP Aljo a MatejËiÊ 1 , Mihovil Ivica 1 , Mladen TomljenoviÊ 1 and Ivan Krolo 2 1 Department of Surgery, and 2 Department of Radiology, Sestre milosrdnice University Hospital, Zagreb, Croatia SUMMARY Fractures of the forearm present a unique management problem for years. Major improvements in the results of management of this injury awaited the development of advanced tech- niques. The introduction of AO implants and AO principles has markedly improved functional re- sults for the patient, depending on the degree of soft tissue injury. Presentation is made of a ten-year follow-up of forearm fractures operatively treated at the Department of Surgery, Sestre milosrdnice University Hospital in Zagreb. The follow-up included 354 forearm fractures in 331 patients. Com- plete forearm shaft fractures were recorded in 121 (34%), fracture of the ulna alone in 130 (37%) and of the radius alone in 102 (29%) patients. Compound fractures occurred in 67 (19%) patients. All patients underwent operative treatment. Compound fracture was the indication for early operation in 85 (24%) patients. Internal fixation was performed by use of a narrow dynamic compression plate (DCP), mostly small DCP, and occasionally semitubular plate. Second and third degree open frac- tures were treated with external fixation. Postoperative plaster immobilization was employed in 39 patients for three to four weeks. Complications included infection (2.8%), nonunion (3.9%), refrac- ture (1.4%), and synostosis (2.8%). Results of surgical treatment were considered excellent in 62%, good in 16%, satisfactory in 12%, and poor in 10% of patients. Key words: Fractures, surgery; Fracture fixation, methods; Forearm injuries, surgery; Osteosynthesis Correspondence to: Assist. Prof. Aljo a MatejËiÊ, M.D., Department of Surgery, Sestre milosrdnice University Hospital, Vinogradska c. 29, HR-10000 Zagreb, Croatia Received May 19, 2000, accepted in revised form July 7, 2000 Introduction A forearm fracture involving either one or both bones, more than any other diaphyseal fracture in the body, re- quires open anatomical reduction with stable fixation, preferably with plates, for optimal functional results. Ana- tomical reduction allows for restoration or normal radial and ulnar length to prevent subluxation of proximal or distal radioulnar joint, and restoration of rotational align- ment essential for normal pronation supination function of the forearm. Stable internal fixation with plates will reduce pain and allow for early soft tissue rehabilitation without the use of external splints or casts. Restoration of forearm and hand function is ensured by the use of plates, either as a tension band axially compressing the fracture, or as a neutralization plate with prior interfragmental compression. Shortcomings of the closed treatment method have long been recognized as malunion, nonunion, and poor functional results 1-3 . Early attempts at functional result improvement by open reduction and internal fixation did little because of unstable fixation and long-term plaster immobilization 4,5 . The introduction of AO implants and principles has changed the outlook dra- matically. Stable internal fixation has eliminated most external casts and splints. The lack of recognition of important biological and biomechanical principles of modern techniques of internal fixation is the most com- mon cause of failure 6,7 . The natural history of forearm fracture, under almost all circumstances, is so uncertain when treated by means of other than anatomical open reduction, stable fixation with plates, and early motion of the extremity, that this