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Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

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I had emergency surgery last week for a forearm fracture I got in a biking accident. The surgeon consulted with several other doctors before putting in a plate with six screws to hold the broken bone together. I wondered if the surgeon knew what he was doing but I was in no shape to argue. What do you think?

Forearm fracture sounds like a straight-forward problem. But surgeons face the difficulty of determining the best way to treat even seemingly simple problems like this one. For example, can this patient be treated nonsurgically with a cast or splint immobilization? If surgery is required, what's the best way to hold the fractured bone together until it heals? Should a metal plate and screws be used or is a long (intramedullary) nail down in the center of the bone better? It's likely these are the things your surgeon was discussing with his colleagues. A review of studies done in this area show that there aren't any studies directly comparing the two treatments. Any conclusions made come from looking all the studies over and making judgments that haven't been tested. In some studies the patients had one of the two forearm bones broken (radius or ulna) and some had both bones broken. The differences between the two bones are enough that ulnar fractures can't be compared to radial fractures as if they were the same. And treating fractures of both bones is clearly different than just treating one forearm bone fracture. There is a clear need for future research in this area. A direct comparison of results between plate and screw fixation and intramedullary nail fixation is needed. Until solid evidence is available to guide surgeons, collaborating with other surgeons is the next best thing in making individual patient decisions. Even with treatment guidelines, each patient can have unique features that require consideration It sounds like you are in good hands with a surgeon who doesn't rush into surgery without careful thought and planning. You can always ask him to review with you all the factors that went into the final decision.


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