Treatment of both bone forearm fractures with 2.7 mm plates: a non-inferiority study

Objectives: To determine the effectiveness of 2.7 mm plates in treating both bone forearm fractures (BBFFs) compared to the current gold standard of 3.5 mm fixation. More specifically, to determine if 2.7 mm plates are non-inferior to the current standard of 3.5 mm plates.

Design: Retrospective including patients from 2016-2021.

Setting: Single institution, level-1 trauma academic medical center.

Patients/participants: 77 patients met inclusion criteria, 58 patients underwent fixation with 3.5 mm plates and 19 underwent fixation with 2.7 mm plates.

Intervention: Plate osteosynthesis with either 2.7 mm or 3.5 mm plate instrumentation.

Main outcome measure: Maintenance of reduction and achievement of fracture union.

Results: Among 77 total patients, 19 received 2.7 mm plates and 58 received 3.5 mm plates. There was no difference in age and BMI between groups, but the 2.7 mm group had fewer males (47% vs 79%, p = 0.02). Primary end points of achievement of union (89.5% vs. 79.3%, p = 0.39) and maintenance of reduction (100% vs. 94.8%, p = 0.99), and secondary end points of implant removal (15.8% vs. 13.8%, p = 0.79), return to the operating room (OR) (5.3% vs. 5.2%, p = 0.63), and minor complications (0% vs. 6.9%, p = 0.99) were similar between the 2.7 mm and 3.5 mm groups.

Conclusion: This study challenges the current standard of ORIF using 3.5 mm plates for diaphyseal forearm fractures. 2.7 mm plating resulted in at least equivocal achievement of fracture union and thus may be more efficacious given previous studies showing lower refracture risks after implant removal.

Level of evidence: Level III, retrospective cohort study.