EP.TH.1043Outcomes of liver resections by trainee surgeons versus consultant surgeon – a single centre experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Umasankar Mathuram Thiyagarajan ◽  
Alaa Al-Mohammad ◽  
Stephanie Goh ◽  
Siong-Seng Liau ◽  
Emmanuel Huguet ◽  
...  
Keyword(s):  
Liver Resection ◽  
Hospital Readmission ◽  
Operative Time ◽  
Bile Leak ◽  
Kidney Injury ◽  
Consultant Surgeon ◽  
Liver Resections ◽  
Trainee Group ◽  
Significant Difference ◽  
Long Term Follow Up

Abstract Introduction Liver resection is a most effective treatment for patients with operable primary or secondary cancer deposits. The role of trainee as a lead surgeon versus consultant surgeon performing liver resections and its impact on surgical outcomes had never been reported. Methods and Materials This study was aimed to assess the liver resection outcomes including operative time, acute kidney injury (AKI), bile leak, sepsis, mortality and hospital readmission within 3 months. A total of 320 liver resections from Addenbookes Hospital at Cambridge between 2015 to 2017 were included in this study. All liver resections were performed under supervision of the consultant surgeon who is either scrubbed or unscrubbed in theatre. Trainee surgeons have performed 116 of 320 as lead surgeon and the consultant surgeons performed the remaining 204. Results The mean operative time was 413±129 versus 383±118 (P = 0.41) minutes in trainee surgeons and consultant surgeons respectively. The incidence of postoperative AKI were similar in between the groups (5/116 versus 11/204;P=0.79). Although the bile leak was numerically high in the trainee group, did not reach statistical difference (13/116 versus 12/204;P=0.12); similar results noted in the incidence of sepsis too (3/116 versus 4/204;P=070). Mortality, hospital readmission at 3 months were (1/204 versus 1/116;P=1) and (2/116 versus 4/204;P=1) respectively. No significant difference was observed. Conclusion Liver resections performed by the trainee surgeons under supervision appeared to be safe without increasing the operative time, morbidity, mortality and hospital readmission at 90 days. Further multicentre prospective study with long-term follow up is recommended.

scholarly journals Extrafascial transfissural approach with finger fracture technique approach for liver resection.Old is still gold?

2020 ◽  
Author(s):  
Bhavin B Vasavada ◽  
Hardik Patel
Keyword(s):  
Multivariate Analysis ◽  
Liver Resection ◽  
Blood Loss ◽  
Operative Time ◽  
Liver Tumors ◽  
Chi Square ◽  
Donor Hepatectomy ◽  
Statistical Significant Difference ◽  
Liver Resections ◽  
Significant Difference

AbstractBackgroundWe evaluated our protocol of extrafascial transfissural approach for liver resection with intrafascial approach that we use in case of donor hepatectomy.Material and MethodWe use extrafascial transfissural approach with finger fracture technique for liver resections and inftrafascial approach with clamp crush technique in case of donor hepatectomy. Major hepatectomy defined as resection of 2 or more adjacent segments.We compared these two techniques with regard to blood loss, operative time, morbidity and mortality.We also evaluated over all factors responsible for 90 days mortality.statistical analysis was done using SPSS version 23.(IBM).Categorical factors were evaluated using chi square test and numerical factors were analyzed using Mann Whitney U test. Multivariate analysis was done using logisitic regression method. Ethical approval for our clinical study was obtained by human research COA number SBI 3246.ResultsWe evaluated 26 liver resections done in last three years. 19 liver resections were done using extrafascial transfissural approach for various liver tumors and 7 living donor hepatectomies were done using itrafascial technique with clamp crush methods. Mean age of patients was 50.73 years.16 patients were males and 10 were females. Mean blood loss was 273.9 ml and mean operative duration was 184.7 minutes. 22 were major resections, 4 were minor liver resections. All minor liver resections were in transfissural approach however there was no statistical significant difference between them. Being live liver doners patients in intrafacial group they were younger than extrafascial transfissural group. (p=0.01). There was no statistical significant difference in blood loss, blood products requirements, morbidity, in hospital and 90 days mortality in both the groups. However extrafascial transfissural with finger fracture technique was associated with significant less operative time. (168.13 minutes vs 222.86 minutes) (p=0.006). 90 days mortality was associated with higher ASA grade (0.018) and blood loss (0.008). However in multivariate analysis no factor indepedently predicted mortality.ConclusionExtrafascial transfissural approach significantly reduces operative time, without affecting morbidity and mortality in liver resection.

scholarly journals Skin autofluorescence as a novel predictor of acute kidney injury after liver resection

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Maciej Krasnodębski ◽  
Karolina Grąt ◽  
Marcin Morawski ◽  
Jan Borkowski ◽  
Piotr Krawczyk ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Liver Resection ◽  
Operative Time ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Extent Of Resection ◽  
Primary Outcome Measure ◽  
Skin Autofluorescence ◽  
Predictive Values ◽  
Risk Patients

Abstract Background Skin autofluorescence (SAF) reflects accumulation of advanced glycation end-products (AGEs). The aim of this study was to evaluate predictive usefulness of SAF measurement in prediction of acute kidney injury (AKI) after liver resection. Methods This prospective observational study included 130 patients undergoing liver resection. The primary outcome measure was AKI. SAF was measured preoperatively and expressed in arbitrary units (AU). Results AKI was observed in 32 of 130 patients (24.6%). SAF independently predicted AKI (p = 0.047), along with extent of resection (p = 0.019) and operative time (p = 0.046). Optimal cut-off for SAF in prediction of AKI was 2.7 AU (area under the curve [AUC] 0.611), with AKI rates of 38.7% and 20.2% in patients with high and low SAF, respectively (p = 0.037). Score based on 3 independent predictors (SAF, extent of resection, and operative time) well stratified the risk of AKI (AUC 0.756), with positive and negative predictive values of 59.3% and 84.0%, respectively. In particular, SAF predicted AKI in patients undergoing major and prolonged resections (p = 0.010, AUC 0.733) with positive and negative predictive values of 81.8%, and 62.5%, respectively. Conclusions AGEs accumulation negatively affects renal function in patients undergoing liver resection. SAF measurement may be used to predict AKI after liver resection, particularly in high-risk patients.

Assessment of Safety and Applicability of Laparoscopic vs Open Non Anatomical Resection of Hepatocellular Carcinoma in Cirrhotic Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Mahfouz Mohammed ◽  
Hany Saeed Abdel Basset ◽  
Mohammed Abd Almegeed Elsayed ◽  
Ahmed Abdel Basset Hegazi
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Laparoscopic Liver Resection ◽  
Operative Time ◽  
Short Term ◽  
Open Liver Resection ◽  
Resection Group ◽  
Significant Difference ◽  
Cirrhotic Patients ◽  
The Mean

Abstract Background Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Liver surgery was one of the last frontiers reached by minimally invasive surgery. Surgical technique and equipment evolved to overcome technical limitations, making laparoscopic liver resections (LLR) safe and feasible. Surgeons developed skills in a stepwise approach, beginning with low complexity operations for benign diseases and reaching high-complexity surgeries for malignant cases and living donor organ harvesting. Objective s: The aim of the study is to compare short term results of laparoscopic versus open hepatectomy regarding to intra operative details and post-operative management and complications for achieving a safe hepatic resection for treatment of HCC in cirrhotic patients. Patients and Methods In this prospective study, a comparison between laparoscopic resection and open resection was done to compare short-term results between laparoscopic and open liver resection. This study was conducted on 30 patients with hepatocellular carcinoma. 15 patients (50%) were treated by laparoscopic liver resection (Group A) while the other 15 patients (50%) were treated by open liver resection (Group B). Results Regarding the demographic data, the presence of past history of medical condition and the preoperative laboratory results, no statistical significance was found. The mean operative time has statistically significant difference between the 2 groups, with decreased operative time in the laparoscopic group (P < 0.001). The mean blood loss has no statistically significant difference relations between the 2 groups, (P = 0.866) with conversion rate of (13.3%) happened in two cases. Conclusion Laparoscopic liver resection is a safe and feasible treatment option for HCC in cirrhotic patient needing minor resection at laparoscopic segments (II, III, IVa,V,VI). Laparoscopic liver resection for HCC has superior short- term and comparable oncological outcomes to open liver resection. LLR should be performed for carefully selected patients and by an expert surgical team.

Feasibility of Nonanatomical Liver Resection in Diligently Selected Patients with Hepatoblastoma and Comparison of Outcomes with Anatomic Resection

2020 ◽  
Author(s):  
Sajid S. Qureshi ◽  
Seema A. Kembhavi ◽  
Mufaddal Kazi ◽  
Vasundhara Smriti ◽  
Akshay Baheti ◽  
...  
Keyword(s):  
Blood Loss ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Treatment Guidelines ◽  
Liver Tumors ◽  
Oncologic Outcomes ◽  
Resection Margins ◽  
Liver Resections ◽  
Significant Difference ◽  
Group Distribution

Abstract Introduction Treatment guidelines for hepatoblastoma discourage nonanatomic liver resections. However, the evidence for this is inadequate and comes from a study performed almost two decades ago which additionally contained inherent limitations. This study aimed to assess the feasibility and oncologic outcomes of nonanatomic resections (NAR) performed in diligently selected patients and compare the results with anatomic resections (AR). Materials and Methods A total of 120 patients who underwent liver resections for hepatoblastoma between January 2008 and July 2019 were reviewed. Feasibility of NAR was based on postchemotherapy relations to vessels, site of the lesion, and possibility of achieving negative resection margins. Results AR was performed in 95 patients and 25 had NAR. The NAR cohort had similar International Childhood Liver Tumors Strategy Group (SIOPEL) risk group distribution. Blood loss and operative times were lower in patients undergoing NAR. No differences were noted between the two groups concerning postoperative morbidity and hospitalization. There were no pathologic positive margins or local recurrences in the NAR patients. Relapse free (RFS) and overall survival (OS) was similar in the two groups (p = 0.54 and 0.96, respectively). Subgroup analysis of only posttreatment extent of tumor (POSTTEXT) I and II patients also showed no difference in RFS or OS for the two groups with a persistent significant difference in operative times and blood loss. Conclusion NAR is feasible with clear margins in carefully selected patients. It is not associated with more complications and outcomes are not inferior to AR. NAR is associated with lesser blood loss and operative time.

Safety and Efficacy of Laparoscopic Liver Resection for Colorectal Liver Metastasis With Obesity

2020 ◽  
pp. 000313482095244
Author(s):  
Yoshihiro Inoue ◽  
Masatsugu Ishii ◽  
Kensuke Fujii ◽  
Kentaro Nihei ◽  
Yusuke Suzuki ◽  
...  
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Laparoscopic Liver Resection ◽  
Operative Time ◽  
Surgical Site Infections ◽  
Obese Patients ◽  
Visceral Fat Area ◽  
Safety And Efficacy ◽  
Estimated Blood Loss ◽  
Significant Difference

Introduction Laparoscopic liver resection (LLR) in obese patients has been reported to be particularly challenging owing to technical difficulties and various comorbidities. Methods The safety and efficacy outcomes in 314 patients who underwent laparoscopic or open nonanatomical liver resection for colorectal liver metastases (CRLM) were analyzed retrospectively with respect to the patients’ body mass index (BMI) and visceral fat area (VFA). Results Two hundred and four patients underwent LLR, and 110 patients underwent open liver resection (OLR). The rate of conversion from LLR to OLR was 4.4%, with no significant difference between the BMI and VFA groups ( P = .647 and .136, respectively). In addition, there were no significant differences in terms of operative time and estimated blood loss in LLR ( P = .226 and .368; .772 and .489, respectively). The incidence of Clavien-Dindo grade IIIa or higher complications was not significantly different between the BMI and VFA groups of LLR ( P = .877 and .726, respectively). In obese patients, the operative time and estimated blood loss were significantly shorter and lower, respectively, in LLR than in OLR ( P = .003 and < .001; < .001 and < .001, respectively). There was a significant difference in the incidence of postoperative complications, organ/space surgical site infections, and postoperative bile leakage between the LLR and OLR groups ( P = .017, < .001, and < .001, respectively). Conclusion LLR for obese patients with CRLM can be performed safely using various surgical devices with no major difference in outcomes compared to those in nonobese patients. Moreover, LLR has better safety outcomes than OLR in obese patients.

scholarly journals Long-term oncological outcomes after laparoscopic parenchyma-sparing redo liver resections for patients with metastatic colorectal cancer: a European multi-center study

2021 ◽  
Author(s):  
Leonid Barkhatov ◽  
Davit L. Aghayan ◽  
Vincenzo Scuderi ◽  
Federica Cipriani ◽  
Åsmund A. Fretland ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Long Term Results ◽  
Colorectal Metastases ◽  
Liver Recurrence ◽  
Liver Resections ◽  
Group 4 ◽  
Significant Difference ◽  
Group 1

Abstract Background Laparoscopic redo resections for colorectal metastases are poorly investigated. This study aims to explore long-term results after second, third, and fourth resections. Material and methods Prospectively updated databases of primary and redo laparoscopic liver resections in six European HPB centers were analyzed. Procedure-related overall survival after first, second, third, and fourth resections were evaluated. Furthermore, patients without liver recurrence after first liver resection were compared to those with one redo, two or three redo, and patients with palliative treatment for liver recurrence after first laparoscopic liver surgery. Survival was calculated both from the date of the first liver resection and from the date of the actual liver resection. In total, 837 laparoscopic primary and redo liver resections performed in 762 patients were included (630 primary, 172 first redo, 29 second redo, and 6 third redo). Patients were bunched into four groups: Group 1—without hepatic recurrence after primary liver resection (n = 441); Group 2—with liver recurrence who underwent only one laparoscopic redo resection (n = 154); Group 3—with liver recurrence who underwent two laparoscopic redo resections (n = 29); Group 4—with liver recurrence who have not been found suitable for redo resections (n = 138). Results No significant difference has been found between the groups in terms of baseline characteristics and surgical outcomes. Rate of positive resection margin was higher in the group with palliative recurrence (group 4). Five-year survival calculated from the first liver resection was 67%, 62%, 84%, and 7% for group 1, 2, 3, and 4, respectively. Procedure-specific 5-year overall survival was 50% after primary laparoscopic liver resection, 52% after the 1st reoperation, 52% after the 2nd, and 40% after the 3rd reoperation made laparoscopic. Conclusions Multiple redo recurrences can be performed laparoscopically with good long-term results. Liver recurrence does not aggravate prognosis as long as the patient is suitable for reoperation.

scholarly journals Is there is a role for laparoscopy for treatment of appendicular mass?

2018 ◽  
Vol 5 (5) ◽  
pp. 1610
Author(s):  
Asem F. Mohammed ◽  
Mahmoud A. Shaheen ◽  
Mahmoud S. Eldesouky
Keyword(s):  
Hospital Readmission ◽  
Operative Time ◽  
Surgical Intervention ◽  
Postoperative Hospital Stay ◽  
Interquartile Range ◽  
Open Approach ◽  
Suspected Appendicitis ◽  
Generalized Peritonitis ◽  
Significant Difference ◽  
Appendicular Mass

Background: The surgical intervention for acute appendicitis presenting with appendicular mass is not well established. The aim of this study was to evaluate the benefits of early laparoscopy and laparoscopic appendectomy (LA) in the treatment of appendicular mass.Methods: During a 1-year period, 48 patients underwent LA for suspected appendicitis (n = 39), generalized peritonitis (n = 1), and an appendicular mass (n = 8).Results: All appendectomies were attempted and done laparoscopically except in one case (appendicular abscess), converted to an open approach. None of appendicular mass patients developed complications. There were no deaths. There was no significant difference between appendicular mass forming patients and non-mass-forming patients who underwent LA for an early appendicular mass as regard to the operative time (median [interquartile range]: 50 [36–60] vs 45 [25–50] min, p = 0.085) and postoperative hospital stay (median [interquartile range]: 2 [1–2] vs [1–2] days, p = 0.1).  Conclusions: Early LA for appendicular mass patients is feasible, safe, and avoids misdiagnoses and the need for hospital readmission.

scholarly journals Comparison of Open Repair vs. the One-Stage Hybrid Extra-Anatomic Technique for Distal Aortic Arch Disease Treatment: Mid-term Outcomes With a Risk-Adjusted Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhiyu Qiao ◽  
Suwei Chen ◽  
Rutao Guo ◽  
Yongliang Zhong ◽  
Yipeng Ge ◽  
...  
Keyword(s):  
Operative Mortality ◽  
Open Repair ◽  
Kidney Injury ◽  
Postoperative Treatment ◽  
Elephant Trunk ◽  
Term Survival ◽  
One Stage ◽  
Significant Difference ◽  
Cord Injury ◽  
Long Term Follow Up

Objective: This study aims to compare the short- and mid-term outcomes of the stented elephant trunk (SET) procedure combined with supra-arch branch reconstruction and one-stage hybrid arch repair combined thoracic endovascular aortic repair (TEVAR) with extra-anatomic bypass in the management of distal arch disease.Methods: From January 2009 to January 2019, 97 patients underwent one-stage hybrid arch repair combined with TEVAR with extra-anatomic bypass (HAR group), and 206 patients underwent the SET procedure with supra-arch branch reconstruction (SET group). We used inverse-probability-of treatment weighting (IPTW) to adjust baseline differences.Results: Before IPTW adjustment, there was no significant difference in operative mortality between the two groups (5.2 vs. 1.0%, P = 0.064). The incidences of stroke, spinal cord injury (SCI), acute kidney injury (AKI), and endoleak also showed no significant differences (4.1 vs. 0.5%, P = 0.066; 2.1 vs. 1.5%, P = 1.000; 0 vs. 1.0%, P = 0.831; 6.2 vs. 1.9%, P = 0.113, respectively). After IPTW adjustment, the incidences of stroke, SCI, and AKI showed no significant differences between the two groups (1.8 vs. 1.1%, P = 0.138; 0.8 vs. 1.6%, P = 0.448; and 0 vs. 0.7%, P = 0.148, respectively). However, the HAR group tended to have higher operative mortality and incidence of endoleak than the SET group (12.4 vs. 1.3%, P = 0.01; 9.9 vs. 1.8%, P = 0.031, respectively). In the multivariate analysis, open repair decreased the risks of endoleak (odds ratio [OR], 0.171, 95% CI, 0.060–0.401; P &lt; 0.001) and operative mortality (OR, 0.093, 95% CI, 0.027–0.238; P &lt; 0.001). The overall survival and event-free survival of the HAR group were significantly lower than those of the SET group (P &lt; 0.001).Conclusion: One-stage hybrid arch repair combined TEVAR with extra-anatomic bypass and the SET procedure with supra-arch branch reconstruction both provided good postoperative treatment outcomes for distal arch disease. However, hybrid arch repair increased the risks of endoleak and operative mortality. The SET procedure provided better mid-term survival than hybrid arch repair without increasing operative mortality. Carefully selecting the indications for the procedure, while receiving close long-term follow-up, may improve the survival rate of patients undergoing hybrid arch repair.

Radiofrequency ablation of colorectal liver metastases

2019 ◽  
Vol 98 (10) ◽  
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Postoperative Mortality ◽  
Disease Free Survival ◽  
Female Ratio ◽  
Liver Resections ◽  
Multi Stage

Introduction: Radical liver resection is the only method for the treatment of patients with colorectal liver metastases (CLM); however, only 20–30% of patients with CLMs can be radically treated. Radiofrequency ablation (RFA) is one of the possible methods of palliative treatment in such patients. Methods: RFA was performed in 381 patients with CLMs between 01 Jan 2001 and 31 Dec 2018. The mean age of the patients was 65.2±8.7 years. The male to female ratio was 2:1. Open laparotomy was done in 238 (62.5%) patients and the CT-navigated transcutaneous approach was used in 143 (37.5%) patients. CLMs <5 cm (usually <3 cm) in diameter were the indication for RFA. We used RFA as the only method in 334 (87.6%) patients; RFA in combination with resection was used in 36 (9.4%), and with multi-stage resection in 11 (3%) patients. We performed RFA in a solitary CLM in 170 (44.6%) patients, and in 2−5 CLMs in 211 (55.6%) patients. We performed computed tomography in each patient 48 hours after procedure. Results: The 30-day postoperative mortality was zero. Complications were present in 4.8% of transcutaneous and in 14.2% of open procedures, respectively, in the 30-day postoperative period. One-, 3-, 5- and 10-year overall survival rates were 94.8, 66.8, 43.9 and 16.6%, respectively, in patients undergoing RFA, and 90.6, 69.1, 52.8 and 39.2%, respectively, in patients with liver resections. Disease free survival was 63.2, 30.1, 18.4 and 13.1%, respectively, in the same patients after RFA, and 71.1, 33.3, 22.8 and 15.5%, respectively, after liver resections. Conclusion: RFA is a palliative thermal ablation method, which is one of therapeutic options in patients with radically non-resectable CLMs. RFA is useful especially in a non-resectable, or resectable (but for the price of large liver resection) solitary CLM <3 cm in diameter and in CLM relapses. RFA is also part of multi-stage liver procedures.

scholarly journals Single-bone versus both-bone plating of unstable paediatric both-bone forearm fractures. A randomized controlled clinical trial

2021 ◽  
Author(s):  
Mohamed Khaled ◽  
Amr A. Fadle ◽  
Ahmed Khalil Attia ◽  
Andrew Sami ◽  
Abdelkhalek Hafez ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Operative Time ◽  
Forearm Fractures ◽  
Inclusion Criteria ◽  
Fracture Union ◽  
Exclusion Criteria ◽  
Bone Fixation ◽  
Fixation Group ◽  
Significant Difference ◽  
Single Bone

Abstract Purpose This clinical trial compares the functional and radiological outcomes of single-bone fixation to both-bone fixation of unstable paediatric both-bone forearm fractures. Methods This individually randomized two-group parallel clinical trial was performed following the Consolidated Standards of Reporting Trials (CONSORT) statement at a single academic tertiary medical centre with an established paediatric orthopaedics unit. All children aged between nine and 15 years who presented to the emergency department at Assiut university with unstable diaphyseal, both-bone forearm fractures requiring surgical intervention between November 1, 2018, and February 28, 2020, were screened for eligibility against the inclusion and exclusion criteria. Inclusion criteria were diaphyseal unstable fractures defined as shaft fractures between the distal and proximal metaphyses with an angulation of > 10°, and/or malrotation of > 30°, and/or displacement > 10 mm after attempted closed reduction. Exclusion criteria included open fractures, Galeazzi fractures, Monteggia fractures, radial head fractures, and associated neurovascular injuries. Patients who met the inclusion criteria were randomized to either the single-bone fixation group (intervention) or the both-bone fixation group (control). Primary outcomes were forearm range of motion and fracture union, while secondary outcomes were forearm function (price criteria), radius re-angulation, wrist and elbow range of motion, and surgical time Results A total of 50 children were included. Out of these 50 children, 25 were randomized to either arm of the study. All children in either group received the treatment assigned by randomization. Fifty (100%) children were available for final follow-up at six months post-operatively. The mean age of single-bone and both-bone fixation groups was 11.48 ± 1.93 and 13 ± 1.75 years, respectively, with a statistically significant difference (p = 0.006). There were no statistically significant differences in gender, laterality, affection of the dominant hand, or mode of trauma between single-bone and both-bone fixation groups. All patients in both groups achieved fracture union. There mean radius re-angulation of the single-bone fixation groups was 5.36 ± 4.39 (0–20) degrees, while there was no radius re-angulation in the both-bone fixation group, with a statistically significant difference (p < 0.001). The time to union in the single-bone group was 6.28 ± 1.51 weeks, while the time to union in the both-bone fixation group was 6.64 ± 1.75 weeks, with no statistically significant difference (p = 0.44). There were no infections or refractures in either group. In the single-bone fixation group, 24 (96%) patients have regained their full forearm ROM (loss of ROM < 15°), while only one (4%) patient lost between 15 and 30° of ROM. In the both-bone fixation group, 23 (92%) patients have regained their full forearm ROM (loss of ROM < 15°), while only two (8%) patients lost between 15 and 30° of ROM. There was no statistically significant difference between groups in loss of forearm ROM (p = 0.55). All patients in both groups regained full ROM of their elbow and wrist joints. On price grading, 24 (96%) and 23 (92%) patients who underwent single bone fixation and both-bone fixation scored excellent, respectively. Only one (4%) patient in the single-bone fixation group and two (8%) patients in the both-bone fixation group scored good, with no statistically significant difference in price score between groups (p = 0.49). The majority of the patients from both groups had no pain on the numerical pain scale; 22 (88%) patients in the single-bone fixation group and 21 (84%) patients in the both-bone fixation groups, with no statistically significant difference between groups (p = 0.38). The single-bone fixation group had a significantly shorter mean operative time in comparison to both-bones plating (43.60 ± 6.21 vs. 88.60 ± 10.56 (min); p < 0.001). Conclusion Single-bone ulna open reduction and plate fixation and casting are safe and had a significantly shorter operative time than both-bone fixation. However, single-bone ORIF had a higher risk radius re-angulation, alas clinically acceptable. Both groups had equally excellent functional outcomes, forearm ROM, and union rates with no complications or refractures. Long-term studies are required.

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