An unusual pattern of segmental forearm fracture in the immature forearm

Abstract

An otherwise healthy 10-year-old boy was admitted to ourinstitution following a fall from a swing in the local park. Onclinicalexaminationtheleftforearmandtherightwristweredeformed. The soft tissue envelope was intact in both fore-arms. There was paraesthesia in the territory of the mediannerve in the left hand, with no sign of a vascular injury ineither limb. Plain radiographs showed his injuries as dis-placed midshaft fractures of the left radius and ulna as wellas a Salter-Harris type II injury to the distal physaes of theipsilateral forearm (Fig. 1a and b). In the contralateralforearm he had sustained a Salter-Harris type II injury tothe distal radial physis with 258 of apex volar angulation.In the accident and emergency department the patientwas given analgaesia, the left arm was placed in an aboveelbow and the right forearm in a below elbow backslab. Thepatient was then prepared for an operation and taken totheatres.Following a general anaesthetic and administration ofprophylactic intravenous antibiotics (Cefuroxime 750 mg),theleftforearm withthesegmentalfracturewasdealt withfirst. Closed reduction was performed for the diaphysealfractures of the radius and ulna under fluoroscopic controland fixed with elastic stable intramedullary nails. The unlawas nailed antegrade and the radius retrograde with2.5 mm diameter nails, as per techniques previouslydescribed.