The forearm plays a pivotal role in upper limb function by acting as a mechanical bridge between the elbow and the wrist while enabling complex movements essential for daily activities.1 Structurally, it consists of two parallel yet mobile long bones—the radius and ulna—whose unique anatomical and functional relationship allows coordinated motion rather than acting as independent units. Fractures involving both bones of the forearm present distinctive challenges to the orthopaedic surgeon because even minor imperfections in alignment, length, or rotation can result in significant functional impairment2. Unlike fractures of single long bones, diaphyseal fractures of both bones of the forearm demand precise anatomical restoration to regain optimal limb function. Forearm rotation, comprising pronation and supination, is the most critical contributor to the rotational mobility of the upper limb. With the shoulder abducted, the majority of upper limb rotation occurs through the forearm itself.3 Many functional activities depend on this motion; for instance, receiving objects into the palm requires near-complete supination, whereas tasks such as typing or writing require varying degrees of pronation. The interosseous membrane plays a vital role in maintaining forearm stability and load transmission. It is better regarded as a ligamentous structure rather than a simple membrane.4 The central band provides axial stability and load sharing between the radius and ulna, while the dorsal oblique band contributes to proximal radioulnar joint stability. The distal membranous portion acts as a secondary stabilizer of the distal radioulnar joint5. Disruption of this complex stabilizing system during fractures can compromise forearm biomechanics if not properly restored. Maintenance of the normal radial bow is crucial for achieving good functional outcomes following forearm fractures. In the normal forearm, the maximal radial bow measures approximately 15 mm and is located at about 60% of the radial length from the distal end. Studies have shown that for forearm rotation to reach at least 80% of the contralateral side, the magnitude of the radial bow should not differ by more than 1.5 mm and its location should not vary by more than 9% compared to the uninjured limb6. Failure to restore this anatomy may lead to restricted rotation, decreased grip strength, and overall functional limitation7.Internal fixation using plate osteosynthesis has become the gold standard for treating diaphyseal fractures of both bones of the forearm. Accurate anatomical reduction and stable fixation facilitate early mobilization and restore near-normal anatomy and motion. However, despite optimal fixation, a modest reduction in forearm, wrist, and grip strength is commonly observed.8The most commonly used implants for forearm fracture fixation include the 3.5 mm Dynamic Compression Plate (DCP) and the 3.5 mm Limited Contact Dynamic Compression Plate (LC-DCP). The LC-DCP design reduces the bone–plate contact area by approximately 50% compared to the conventional DCP, theoretically preserving periosteal blood supply and minimizing cortical bone necrosis. 9 AIM To study the functional outcome of plating of diaphyseal fracture of BBFA with LC-DCP in adults, using Andersons et al scoring system.

This prospective, time-bound study was conducted at department of Orthopaedics at a JLN medical college, Ajmer over a period of 1 yr years from period 1 july 2024 to 30 june 2025, and included 42 patients with fractures of both bones of the forearm. All cases were treated by open reduction and internal fixation using a 3.5 mm limited contact dynamic compression plate (LC-DCP). The study population comprised adult patients with diaphyseal fractures of both the radius and ulna who were deemed fit for surgical intervention. Both closed fractures and Gustilo–Anderson type I open fractures were included. Patients who were medically unfit for surgery, those with open fractures other than Gustilo type I, Gustilo–Anderson type II and III open fractures, children below 18 years of age, and patients with pathological fractures were excluded from the study.

Table 1: Age Distribution of Study Population (n = 42) Age group (years) Number of patients Percentage 18-30 10 23.8 31-40 11 26.2 41-50 14 33.3 >50 7 16.7 Total 42 100 The study population included 42 patients, with the majority aged between 41 and 50 years (33.3%), followed by 31–40 years (26.2%), 18–30 years (23.8%), and those above 50 years (16.7%). This distribution indicates that middle-aged adults were the most commonly affected group. Table 2: Side of Forearm Involved Side involved Number of patients Percentage Right 24 57.1 Left 18 42.9 Of the 42 patients included in the study, the right forearm was involved in 24 cases (57.1%), while the left forearm was affected in 18 cases (42.9%). This shows a slightly higher incidence of fractures on the right side. Table 3: Mode of Injury Mode of injury Number of patients Percentage RTA 22 52.4 Fall from height 12 28.6 Assault 6 14.3 Sports injury 2 4.7 Among the 42 patients, the most common mode of injury was road traffic accidents, accounting for 22 cases (52.4%), followed by falls from height in 12 patients (28.6%). Assault and sports-related injuries were less frequent, occurring in 6 (14.3%) and 2 (4.7%) cases, respectively. Table 4: Type of Fracture Fracture type Number of patients Percentage Closed 34 81.0 Gustilo–Anderson type I 8 19.0 Out of the 42 patients, the majority sustained closed fractures, which accounted for 34 cases (81%), while Gustilo–Anderson type I open fractures were seen in 8 patients (19%). Table 5: Level of Fracture Level of fracture Number of patients Percentage Proximal third 6 14.3 Middle third 24 57.1 Distal third 12 28.6 Fractures of the middle third of the forearm were most common, occurring in 24 patients (57.1%), followed by distal third fractures in 12 patients (28.6%) and proximal third fractures in 6 patients (14.3%). Table 6: AO Classification and Average Time for Union AO fracture type Number of patients Average time for union (weeks) 22-A3 10 13.8 22-B3 9 16.2 22-C1 8 17.5 22-C2 7 19.1 22-C3 8 21.4 The average time for fracture union varied according to AO fracture type, with 22-A3 fractures uniting fastest at 13.8 weeks and 22-C3 fractures taking the longest at 21.4 weeks. Table 7: Duration of Fracture Union (n = 42) Duration of union (weeks) Number of patients Percentage ≤14 weeks 16 38.1 15–18 weeks 14 33.3 19–22 weeks 8 19.0 >22 weeks 4 9.6 In the study, 16 patients (38.1%) achieved fracture union within 14 weeks, while 14 patients (33.3%) united in 15–18 weeks. Eight patients (19%) required 19–22 weeks for union, and 4 patients (9.6%) took more than 22 weeks. Table 8: Complications Observed Complication Number of patients Percentage Superficial infection 4 9.5 Delayed union 3 7.1 Non- union 2 4.8 Implant failure 1 2.4 Restricted forearm rotation 3 7.1 No complications 29 69.1 Among the 42 patients, 29 (69.1%) experienced no complications, while the remaining cases had issues such as superficial infection in 4 patients (9.5%), delayed union in 3 (7.1%), non-union in 2 (4.8%), implant failure in 1 (2.4%), and restricted forearm rotation in 3 patients (7.1%). Table 9: Criteria for Evaluation of Functional Outcome (Anderson et al.) Outcome Fracture union Loss of forearm rotation Wrist movement Excellent Union <10° Full Satisfactory Union 10°–30° Mild restriction Unsatisfactory Union >30° Moderate restriction Failure Non union Severe limitation Severe restriction Functional outcomes were evaluated based on fracture union, loss of forearm rotation, and wrist movement. Excellent outcomes were defined as union with less than 10° loss of rotation and full wrist movement, satisfactory as union with 10°–30° loss and mild restriction, unsatisfactory as union with more than 30° loss and moderate restriction, and failure as non-union with severe limitation and wrist restriction. Table 10: Final Functional Outcome (Anderson et al. Criteria) Outcome Excellent 26 61.9 Satisfactory 10 23.8 Unsatisfactory 4 9.5 Failure 2 4.8 Among the 42 patients, 26 (61.9%) achieved an excellent outcome, 10 (23.8%) had satisfactory results, 4 (9.5%) were classified as unsatisfactory, and 2 patients (4.8%) experienced failure.

The study population included 42 patients with fractures of both bones of the forearm. The age distribution showed that 10 patients (23.8%) were between 18 and 30 years of age, while 11 patients (26.2%) fell in the 31–40 years age group. The largest proportion of patients, 14 (33.3%), were in the 41–50 years age group. Seven patients (16.7%) were older than 50 years. In 2007, Kurt. P. Droll9 found 43.9 years as an average (18-73). In the present study of 42 patients with fractures of both bones of the forearm, the right side was more commonly affected, involving 24 patients, which accounts for 57.1% of the cases. The left side was involved in 18 patients, representing 42.9% of the total. In 2007, Kurt. P. Droll9 reported about 53%cases of right forearm fractures and 45% cases of left forearm fractures. In the present study of 42 patients with fractures of both bones of the forearm, the most common mode of injury was road traffic accidents, accounting for 22 cases or 52.4% of the total. This was followed by falls from height, which occurred in 12 patients, representing 28.6% of cases. Injuries resulting from assault were observed in 6 patients, making up 14.3% of the study population. Sports-related injuries were the least common, seen in only 2 patients, accounting for 4.7%. In 2010 Peter kloen noted, RTA (63%), fall (30%) and assault (7%) of patients. In the present study of 42 patients with fractures of both bones of the forearm, the majority of cases were closed fractures, accounting for 34 patients, which corresponds to 81.0% of the study population. Open fractures were less common, with 8 patients presenting with Gustilo–Anderson type I injuries, representing 19.0% of cases. Closed fractures typically result from low-energy trauma and generally have a better prognosis due to minimal soft tissue injury. Gustilo–Anderson type I fractures involve a small, clean wound with minimal contamination and limited soft tissue damage. In the present study of 42 patients with fractures of both bones of the forearm, the level of fracture was categorized into proximal, middle, and distal thirds. Fractures involving the proximal third were the least common, occurring in 6 patients, which accounted for 14.3% of cases. The majority of fractures were located in the middle third, with 24 patients representing 57.1% of the study population. Distal third fractures were observed in 12 patients, making up 28.6% of cases. In the series reported by Chapman,10 fractures of both bones of the forearm were most commonly located in the middle third, accounting for 59% of cases. This was followed by fractures involving the distal third, which constituted 28% of the total, while fractures of the proximal third were least common, comprising 13% of cases. In the study, the AO fracture classification was used to categorize diaphyseal fractures of both bones of the forearm. Among the 42 patients, 10 had 22-A3 type fractures, which showed the fastest average time for union of 13.8 weeks. Nine patients had 22-B3 fractures, with an average union time of 16.2 weeks. Eight patients presented with 22-C1 fractures, uniting on average in 17.5 weeks, while 7 patients had 22-C2 fractures with a longer union time of 19.1 weeks. The most complex fractures, 22-C3, were seen in 8 patients and required an average of 21.4 weeks for union. The duration of fracture union among the 42 patients varied, with the majority achieving union within 14 weeks, accounting for 16 patients (38.1%). Fourteen patients (33.3%) showed union between 15 and 18 weeks. Eight patients (19.0%) required 19 to 22 weeks for union, while only 4 patients (9.6%) took more than 22 weeks to achieve complete union. In the study, complications following internal fixation of both bone forearm fractures were relatively uncommon. Superficial infection was observed in 4 patients, accounting for 9.5% of cases. Delayed union occurred in 3 patients (7.1%), while non-union was seen in 2 patients (4.8%). Implant failure was reported in 1 patient (2.4%). Restricted forearm rotation affected 3 patients (7.1%).According to Anderson11, the complications observed following internal fixation of both bone forearm fractures were relatively uncommon. Superficial infection occurred in 2.9% of cases, while refracture, fracture at the end of the plate, or fracture through the compression hole was also reported in 2.9% of patients. Non-union was seen in 2.9% of cases, and post-operative interosseous nerve injury occurred in 2% of patients. Radio-ulnar synostosis was the least frequent complication, occurring in 1.2% of cases. The functional outcome of forearm fractures was assessed using Anderson et al.’s criteria, which consider fracture union, loss of forearm rotation, and wrist movement. An excellent outcome is defined as complete union with less than 10° loss of forearm rotation and full wrist movement. A satisfactory outcome corresponds to union with 10°–30° loss of forearm rotation and mild restriction of wrist movement. Unsatisfactory results are seen when there is union but more than 30° loss of rotation and moderate wrist restriction. Failure is defined as non-union accompanied by severe limitation of forearm rotation and severe restriction of wrist movement. In 1995, M.D. Mcknee12 found 10.7 weeks as average union time with 97.3% union rate . In the present study of 42 patients with fractures of both bones of the forearm, functional outcomes were assessed using Anderson et al.’s criteria. Excellent results were observed in 26 patients, accounting for 61.9% of the cases, indicating successful restoration of fracture union, forearm rotation, and wrist movement. Satisfactory outcomes were seen in 10 patients (23.8%), where minor limitations in motion were present but overall function was acceptable. Unsatisfactory results occurred in 4 patients (9.5%), reflecting a significant loss of forearm rotation or moderate restriction of wrist movement. Failure was noted in 2 patients (4.8%), both of whom had non-union and severe functional limitations.In 2010 Peter kloen13 found 29(62%) with excellent results, 8(17%) as satisfactory and 10 (21%) cases of unsatisfactory result.

In this prospective study of 42 patients with fractures of both bones of the forearm treated with open reduction and internal fixation using 3.5 mm LC-DCP, the majority of patients were middle-aged adults, with a slightly higher incidence of right-sided fractures. Road traffic accidents were the most common mode of injury, and closed fractures predominated. Fractures most frequently involved the middle third of the forearm, consistent with previously published series. AO classification correlated well with fracture complexity and healing time, with simple fractures (22-A3) uniting fastest and highly comminuted fractures (22-C3) taking the longest. The average time to union was 16.5 weeks, with most fractures achieving union within 18 weeks. Complications were uncommon, with superficial infection, delayed union, non-union, and restricted forearm rotation being the most frequently observed. Functional outcomes assessed by Anderson et al.’s criteria were favorable, with 61.9% of patients achieving excellent results and 23.8% satisfactory outcomes. Unsatisfactory results and failures were infrequent and primarily associated with complex fractures. Overall, internal fixation with LC-DCP provided stable fixation, reliable fracture union, and restoration of forearm rotation, wrist motion, and grip strength, confirming its effectiveness as a treatment modality for diaphyseal fractures of both bones of the forearm.

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