Before we talk about how to treat these injuries, we need to discuss the rationale for treatment. In the past, complication rates for conservative care (casting) of both bones of forearm fractures were very high. Sir John Charnley, who is better known for his contributions to arthroplasty, wrote a landmark paper on the closed treatment of forearm fractures in 1961 in the British JBJS. He quoted a 30-40% complication rate of malunion, nonunion, loss of forearm rotation, etc.. It is clear that the closed treatment of this injury produced many poor results.

Why were these fractures being treated closed in 1961? Earlier reports, including one by Knight and Purvis in the American JBJS in 1949 showed that inadequate fixation with small caliber nails, pins or plates led to high complication rates. Initial surgical forays into this area of orthopaedic injury were complicated by a lack of implants specially designed for this area. The complications of operative treatment led to a wave of enthusiasm for conservative treatment which produced its own high complication rate.

In 1975, a landmark paper by Anderson showed that the AO small fragment dynamic compression plates produced reliable healing of these fractures in 96-98% of cases. This paper popularized the technique of compression plating for forearm fractures. The results were dramatically superior to those reported previously with inadequate fixation or closed treatment alone. This explains the current treatment of forearm fractures. In my opinion, compression plating for diaphyseal fractures is the gold standard against which all other methods should be compared. While there is enthusiasm for other types of fixation such as intramedullary fixation, etc., to the best of my knowledge, there is no good prospective or comparative study which shows that any other treatment method produces better results than a standard open fixation with a small fragment compression plate. I think this is something we should remember when looking for new techniques with which to treat these fractures.