Functional Outcomes of Both Bones Forearm Fractures in Adults: A Systematic Review with Meta-analysis

Abstract Background: Both-bone forearm fracture is a common fracture that affects both adults and children. The optimal treatment for this fracture has been studied, particularly the choice between open reduction and internal fixation (ORIF) with plates and intramedullary nails (IMNs). This study aims to provide further insight into this issue by comprehensively studying the functional outcome of this fracture in adults. Methods: A literature search was conducted in PubMed, Scopus, Embase, Web of Science and Cochrane Library to identify studies evaluating functional outcomes of both bone forearm fractures treated with ORIF and IMNs in adults. Studies that assessed the Disabilities of the Arm, Shoulder and Hand (DASH) score and criteria by Grace–Eversmann and Anderson were included. Ten studies fulfilled the study criteria and were included in the analysis, including pooled analysis, subgroups analysis and meta-analysis for the outcome of ORIF with plates and intramedullary nails (IMNs). Results: The meta-analysis included 352 patients with a pooled mean age of 37.25 years, 69% of whom were males. The pooled DASH score was 10.5, indicating excellent patient-reported functional outcomes, though with significant heterogeneity ( I 2 = 86.39). The pooled rate of good to excellent functional outcomes was 87.1% based on the Grace–Eversmann and Anderson criteria, with moderate heterogeneity ( I 2 = 48.9). Subgroup analyses and meta-analyses for studies with control groups revealed no significant difference in functional outcomes between ORIF and internal fixation nails (IMNs) (OR 1.58, I 2 = 47.77). Conclusion: The study findings suggest that both methods yielded favourable outcomes supporting the previous systematic reviews. Surgical decisions could be influenced by other factors such as fracture characteristics, surgeon expertise and patient preferences. Further studies on the cost-effectiveness of treatment could enhance our understanding of the optimal approach for these fractures.