Fractures of the radius and ulna in adults: an analysis of factors affecting outcome.
Concurrent data were collected by the authors for 104 fractures of the shafts of the radius and ulna in 102 adult patients to determine the relationship of subjective, objective, radiographic and economic outcome parameters to the method of treatment, type of fracture (open or closed), degree of comminution, and the presence of other injuries. Patients treated by open reduction and internal fixation (ORIF) had less pain, lost less forearm rotation, and returned to the same work following injury more frequently than those treated by closed reduction and casting (CR) or pins-in-plaster (PIP). The greatest advantages of ORIF over other treatment methods were improved skeletal alignment and forearm rotation, the factors most often associated with return to the same work following injury. Except for a longer time to union and a higher rate of infection, the outcomes of open and closed fractures were very similar. The presence of other injuries was a strong predictor of a compromised end result, primarily because of more pain, greater loss of forearm rotation, and less frequent return to the same work. The inclusion of patient satisfaction and work status in the assessment of outcomes and the concept of "functional malunion", an outcome-based interpretation of a radiographic finding, should help in counselling patients as to the likely economic and functional impacts of these injuries.