Refracture risk after plate removal in the forearm

In this study we report the results of a retrospective examination of 401 patients who had 459 plates removed from the forearm after successful union. Data were assembled from seven studies that have appeared in the literature. The authors of these seven studies were contacted and asked to complete a detailed questionnaire concerning refracture and the specific type of plating hardware used. The plating systems used varied according to plate design [dynamic compression plate (DCP), semi-tubular, one-third tubular], plate material stainless steel (SS), titanium/titanium alloy (Ti), and screw size (3.5 mm, 4.5 mm). A total of 37 refractures occurred in 29 patients. There were no refractures after the removal of 76 stainless steel, one-third tubular plates; 10 refractures after the removal of 177 stainless steel, small fragment DCP; six refractures after the removal of 91 stainless steel, semitubular plates; and 20 refractures after the removal of 96 stainless steel, narrow, large-fragment DCP. The corresponding refracture rates are: 0.0, 5.6, 6.6, and 21%, respectively. There were insufficient numbers of titanium or titanium alloy plates to calculate refracture rates for plates made from these materials. The refracture risk associated with the narrow, large-fragment DCP system was significantly greater than with either the small-fragment DCP system (p < 0.005) or the one-third tubular system (p < 0.001). There was also a trend for greater risk (p = 0.057) associated with the large-fragment DCP system in comparison with the semitubular system.