I would like to thanks Dr. Rajasekhar for his comments.

Regarding implant removal, it is true that there is still no well established indication for this procedure. We explained the pros and cons and gave the option of implant removal to the patient when they were recruited in the study. However, the decision for removal was entirely made by the patient. Moreover, the 40% rate of implant removal was similar to other kinds of fixation in our institution, e.g. intramedullary nailing, plate fixation of ankle fractures, and most of these are due to patients' request. I strongly believe that there is a cultural reason behind such request.

There is of course a newer implant,the Locking compression plate (LCP),that uses the locking screw principle. While we are currently using this new implant, we are not aware of any data on randomised control trial showing an advantage over either LC-DCP or PC-Fix. Hence, we feel that the advent of LCP does not decrease the value of our study which compares purely two schools of philosophy in plating, namely interfragmentary fixation and bridging plate fixation. The use of mixed conventional and locking head screws in LCP would not allow such comparison.

We read with interest “ A prospective, randomised trial comparing the limited contact dynamic compression plate with the point contact fixator for forearm fractures”(2003;85:343-48), by Leung and Chow, a well executed study with good numbers and adequate follow up.

It was not clear to us why the decision to remove the devices (22 PC-Fix devices and 29 LC-DCP devices totalling 40.8%) was taken? It is very unlikely that there was a definite clinical indication to remove the implants. It is well established in the literature that by removing the implants we are not only subjecting the patients to an unnecessary second surgery but also exposing them to a substantial complication rate including infection and nerve injury. If looking at the refracture rate was the only aim to remove the devices, we believe that this was unnecessary. A valid and reliable comparison between the two groups could have been achieved by assessment of bone healing, patient function, and complications with radiographs and clinical examination alone.

The advent of the locking compression plate system (LCP) ensures more biological fracture healing with plating devices. The LCP which has a combination hole, gives the surgeon, the choice to use conventional screws, locking screws or a combination of both. This, we feel, will reduce the use of the PC-Fix device for fixation of forearm fractures in the near future.