Executive Editor: Peter Trafton

Authors: Kodi Kojima, Steve Velkes

Proximal forearm 21-A1.2 ORIF

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1 Compression plate principles top


In transverse fractures, compression can only be achieved using a preloaded plate. Slight overbending of the plate is necessary to ensure compression of the far cortex.

Sequence of screw insertion:

  • The first screw should be inserted in neutral position.
  • A second screw is inserted eccentrically into the opposite fragment.

2 Reduction and preliminary fixation top

Cleaning the fracture site

Expose the fracture ends with minimal soft tissue dissection off the bone.

Remove hematoma and irrigate.

Reduction can be achieved by direct or indirect reduction techniques.


Direct reduction

Reduce the fracture with the help of two small pointed reduction forceps...


...and provisonally fix it with two K-wires or reduction clamps.


Reduction with a plate

Fix the contoured and prebent plate with one screw to the proximal fragment. Then reduce the distal fragment against plate and proximal fragment by manipulation of the distal ulna, possibly aided by a clamp outside the fracture site. Final adjustment of the screw may affect reduction, and may be delayed until a screw is placed in the distal fragment.

In minimally displaced fractures this reduction might be achieved indirectly.

3 Plate preparation top


Implant choice

Use a six hole plate. Usually, three screws in each fragment provide sufficient stability.

The plate may be a small fragment (3.5 mm) dynamic compression plate (DCP), a limited contact dynamic compression plate (LC-DCP), or a locking plate (LCP) with conventional screws.

In osteoporotic bone there is an indication for the use of a an LCP in combination with locking head screws.


Contouring the plate

Contour the plate according to the surface anatomy of the ulna. Place a slight convex bend over the fracture to ensure compression of the opposite cortex.

Contour the plate with bending irons or bending press.

4 Creating compression top


Apply a 3.5 mm cortical screw in neutral position into the proximal fragment next to the fracture.

Insert a 3.5 mm cortical screw in eccentric position into the distal fragment, next to the fracture, creating compression across the fracture.

5 Finish fixation top


Insert the rest of the screws in neutral position.

Finally, assess the range of motion in pronation, supination, flexion and extension.

Check results with image intensifier or x-ray.

v1.0 2007-10-14