This 10-year retrospective series from the Campbell Clinic (1960-1970) reports outcomes of ASIF compression plate fixation for 330 acute diaphyseal forearm fractures in 244 adults. It evaluates whether this technique reliably achieves union and restores forearm function, and defines the technical principles that govern success and failure.
Adult forearm shaft fractures are unforgiving — the pronating and supinating muscles apply constant rotational and angular forces that make closed treatment nearly futile, with functional failure rates as high as 92% in historical series. This paper established compression plate ORIF as the definitive standard and codified the technical rules that make it work.
When you plate a forearm fracture, approach dictates plate surface: Henry volar for distal-half radius, Thompson dorsal for proximal-half radius (protects the radial nerve and avoids blocking pronation). If comminution exceeds one-third of the shaft circumference, add a primary iliac bone graft. The union rate with grafting matches non-comminuted cases, so this threshold is your rescue maneuver for high-energy injuries.
For open forearm fractures, delay fixation 1-3 weeks to confirm a clean wound: 38 open fractures fixed this way had zero infections and 97.4% union. Leave plates in place 12-18 months and protect with a splint after removal. Early removal is why refractures happen, and this series eliminated that complication entirely once the protocol changed.
The 1.2% synostosis rate is a counseling point: it occurs with comminuted both-bone fractures at the same level, not because of the plate itself.
This 10-year retrospective series from the Campbell Clinic (1960-1970) reports outcomes of ASIF compression plate fixation for 330 acute diaphyseal forearm fractures in 244 adults. It evaluates whether this technique reliably achieves union and restores forearm function, and defines the technical principles that govern success and failure.
Adult forearm shaft fractures are unforgiving — the pronating and supinating muscles apply constant rotational and angular forces that make closed treatment nearly futile, with functional failure rates as high as 92% in historical series. This paper established compression plate ORIF as the definitive standard and codified the technical rules that make it work.
When you plate a forearm fracture, approach dictates plate surface: Henry volar for distal-half radius, Thompson dorsal for proximal-half radius (protects the radial nerve and avoids blocking pronation). If comminution exceeds one-third of the shaft circumference, add a primary iliac bone graft. The union rate with grafting matches non-comminuted cases, so this threshold is your rescue maneuver for high-energy injuries.
For open forearm fractures, delay fixation 1-3 weeks to confirm a clean wound: 38 open fractures fixed this way had zero infections and 97.4% union. Leave plates in place 12-18 months and protect with a splint after removal. Early removal is why refractures happen, and this series eliminated that complication entirely once the protocol changed.
The 1.2% synostosis rate is a counseling point: it occurs with comminuted both-bone fractures at the same level, not because of the plate itself.