Conventional compression plating has been found effective in treating forearm diaphyseal fractures, providing stability as well as resistance to axial, torsional, and bending forces. Locked plating has provided stability without frictional force between the bone-plate interface, which may help preserve periosteal blood supply, and is useful in treating metaphyseal, comminuted, and osteoporotic fractures. Hybrid plating has been used in an attempt to combine the strengths of these two techniques; however, in the context of simple forearm diaphyseal fractures with healthy bone, its effectiveness is only theoretical. We describe two patients in whom open reduction and internal fixation with hybrid plating to treat radius and ulna diaphyseal fractures resulted in nonunion. We performed a revision procedure using conventional compression plating and achieved full healing with complete union in both cases. These findings suggest that hybrid fixation for treating such fractures may not lead to better outcomes than conventional plating.
Cheema, Zainab; Nathan E. Huff; and Deana M. Mercer. "Nonunion After Hybrid Plating with Locking and Nonlocking Screws in Radius and Ulna Shaft Fractures: Report of Two Cases." UNM Orthopaedic Research Journal 4, 1 (2015). https://digitalrepository.unm.edu/unm_jor/vol4/iss1/20