Background: Computed tomography (CT) is one of the most practical and accurate diagnostic imaging techniques to evaluate bones and joints in small animals. Objectives: The present study aimed to investigate the morphology and osteometric measurements of the Persian cat’s antebrachium bones based on CT images. Methods: This cross-sectional descriptive study was conducted on 10 healthy adult Persian cats (5 males and 5 females). The anesthetized Persian cat was placed in a dorsoventral position on the CT scanner table with its forelimbs fully extended, and sagittal, transverse, and dorsal scans were performed from the proximal extremity of the metacarpals to the distal third of the humerus. Results: Based on the study results, CT provides the possibility of identifying most of the anatomical structures of the forearm area of the Persian cat. In the CT images, the bones appeared white due to their high density, and their medullary cavities were dark. Additionally, muscles and tendons were visible on different gray scales. The structural details of the joint between the proximal extremity of the radius and the capitulum of the humerus and the joint between the distal extremity of the radius and the radial carpal bone could be better evaluated in the transverse CT plane. Proximal radioulnar and radiohumeral joints were examined better in transverse and sagittal CT plans. All details related to the olecranon, anconeal, and coronoid processes were visible in sagittal, transverse, and dorsal CT reconstructions. The structural features of the joint between the semilunar notch and trochlea of the humerus were more visible in the dorsal CT plane. Based on transverse CT images, the thickness of the cortex and the internal diameter of the medullary cavity of the radius and ulna bones were measured and statistically analyzed. Conclusion: The results of this research indicate that the anatomical structures of the antebrachium bones of Persian cats are similar to those of other domestic cats. The study findings can be utilized in the teaching of computed tomographic anatomy, the interpretation of CT scan images, and performing clinical and treatment examinations of this breed of cat.

Recommendations for tracking the residual forearm in people with trans-radial limb difference using marker-based motion capture.

Skeletal tuberculosis (TB) remains a significant clinical entity, particularly in developing nations, where extrapulmonary TB contributes substantially to morbidity. TB involving the upper limb bones is rare, particularly in the pediatric population. We report a case of isolated ulnar bone TB in an 11-year-old girl who was initially misdiagnosed as having a traumatic ulnar fracture following minor trauma. Diagnosis was confirmed through microbiological examination using Ziehl-Neelsen staining, cartridge-based nucleic acid amplification test, and culture. After pus aspiration, sinus excision, and daily wound care, antitubercular therapy was initiated based on the patient's body weight according to the pediatric TB guidelines. Following immobilization in cast and structured rehabilitation, the patient achieved radiological and functional recovery over 15 months. This case highlights the diagnostic challenges of atypical skeletal TB and emphasizes the significance of early suspicion, microbiological confirmation, and tailored conservative management for achieving excellent outcomes.

Aging plays a major role in the development of numerous chronic diseases, one of which is a marked decline in skeletal health. Beyond diminishing bone mass and strength, mammals of advanced age experience a decline in skeletal mechanotransduction—that is, the ability of the skeleton to respond adaptively to mechanical perturbation. One possibility for the loss of mechanotransduction in bone with aging is an age-associated increase in the population density of senescent cells—those cells that have undergone irreversible cell cycle arrest, resistance to apoptosis, and production of a modified secretome (the SASP) that has damaging effects to nearby healthy (non-senescent) cells. We investigated whether the presence of senescent cells might drive some of the diminished mechanical response observed in aged bone, by testing the hypothesis that the clearance of senescent cells via intermittent senolytic treatment promotes mechanical responsiveness in an aged skeleton. C57BL/6 mice aged 6 months and 22 months were treated weekly with the senolytic cocktail Dasatinib and Quercetin (D + Q) for 1 month, then subjected to low level in vivo mechanical loading of the ulna for 1 week. The 6-month-old mice exhibited a doubling of load-induced ulnar periosteal bone formation when treated with D + Q, compared to vehicle-treated mice, but the periosteal response to loading was not significantly altered by D + Q in the aged (22-month) mice. We further probed the efficacy of D + Q in mechanotransduction by switching to an endocortical model—the axial tibia loading system. Here, the 22-month-old mice had nearly double the load-induced endocortical bone formation compared to vehicle-treated mice. We further assayed the cortical bone gene expression profile in loaded and control tibias from treatment-naïve 6-month and 22-month mice, to determine whether there is significant overlap between mechanically induced signaling genes and SASP genes. We found significant load-induced changes among several SASP genes, suggesting that inhibition of the SASP (i.e., senomorphics) might interfere with mechanical signaling from otherwise healthy cells. In summary, clearance of senescent cells via intermittent D + Q treatment is effective at improving endocortical mechanical responsiveness in the aged skeleton, which is commonly diminished throughout the course of aging.

Threaded K-wire vs cortical screw fixation in O'Driscoll type 2 and 3 coronoid fractures: a comparative biomechanical study.

The treatment of large segmental bone defects has always been a medical challenge. Although various methods have been developed, each of them has its own drawbacks. To overcome the drawbacks, in situ tissue regeneration has bright prospects. Herein, we developed dipyridamole (D)/calcium sulfate (CS)-loaded, gelatin (G)-coated porous β-tricalcium phosphate (TCP) scaffolds using an indirect 3D printing and surface coating method to treat the 15 mm ulnar bone defects of rabbits. In vitro simulation experiments demonstrated that the as-prepared scaffolds could establish a dynamic acidic microenvironment with relative and variable concentrations of D, calcium ion, and phosphate anion. In vitro mesenchymal stem cell (MSC) coculture experiments displayed that four components, G, D, CS and TCP, could synergistically regulate the adhesion, proliferation, recruitment, migration, and osteogenic differentiation of MSCs. In vivo experiments displayed that the as-prepared scaffolds could recruit and capture endogenous MSCs, mediate the ulnar bone defects to bridge within 12 weeks, and match a desirable degradation rate. The as-prepared scaffolds with high in situ osteogenic activity are attributable to the synergistic effect of four components, which regulated the osteoblastic-osteoclastic imbalance of the bone remodeling cycle.

Determination of height is a major component of routine growth monitoring of wellness in child welfare clinics, and it is essential to many preventive child health interventions. Monitoring a child`s height alongside weight and physical development is routinely done as part of child health care in many countries, including Nigeria. The most accurate method of determining a child’s height is to use a standard calibrated stadiometer. However, this may not always be practicable in cases of emergent illnesses like severe dehydration with shock or severe respiratory distress, the need for urgent resuscitation and restriction of patient’s movements may pose challenges to height measurement. Nelson formula has been useful for quick estimation of children’s height in such difficult situations. The accuracy of other methods of height estimation, such as the formulae involving the use of ulna bone length, hand length and even mid-parental height, has been shown to vary amongst populations. This review aimed to bring to the limelight the various methods, factors affecting height and clinical importance of height measurements as a significant growth index among paediatrics age group.

Osteoporosis is a prevalent metabolic bone disease that frequently remains undiagnosed due to limited access to bone mineral density (BMD) tests, such as Dual-energy X-ray absorptiometry (DXA). To address this issue, recent research explores alternative indicators from peripheral skeletal sites to enable earlier and more accessible screening. In this paper, we propose a method to predict osteoporosis using hand and wrist X-ray images, which are widely available and cost-effective, though their association with DXA-based diagnoses is not yet fully established. Our approach employs an image segmentation model utilizing a mixture of probabilistic U-Net decoders, which captures predictive uncertainty when segmenting the ulna, radius, and metacarpal bones. The segmentation task is formulated as an optimal transport (OT) problem, effectively addressing the variability inherent in medical images. Additionally, we adopt a self-supervised learning (SSL) strategy that pretrains the model on augmented, unlabeled data to learn robust, invariant feature representations. These features are subsequently fine-tuned in a supervised classification task to distinguish osteoporotic from normal cases. We evaluate our method on X-rays from 192 individuals with verified DXA diagnoses. By combining uncertainty-aware segmentation and self-supervised feature learning, our framework offers a promising vision-based strategy for early osteoporosis detection using peripheral X-ray imaging.

Objectives:Background: Olecranon stress fracture (OSF) is a pitching-related injury with an incidence rate of 5.4% among baseball elbow injuries. In a previous report, we classified OSF into five types (Furushima classification) and investigated its mechanism of onset, concluding that elbow valgus stress is involved. Since then, there have been no new studies on the mechanism, and only a few reports have detailed surgical methods using screw fixation, with no comprehensive analysis of surgical outcomes. OSF often presents as a nonunion, leading to calcification and bone sclerosis at the fracture site. This complicates the freshening of the sclerotic fracture site, making bone union difficult to achieve with screw compression alone. We have encountered cases where patients were referred to our hospital due to poor bone union following DTJ screw fixation at other facilities. As such, OSF remains challenging to treat, and there is currently no consensus on the optimal treatment approach. We have consistently treated OSF by inserting a bone peg into the nonunion site to facilitate fracture healing, achieving very good results. To evaluate the clinical outcomes of OSF in baseball players who underwent surgical treatment, categorized by fracture type according to the Furushima classification, and to report on the surgical techniques and outcomes associated with each OSF type.Methods:This study included 147 cases out of 171 male baseball players (mean age, 17.0 years; age range, 14–23 years) who underwent surgery for olecranon stress fractures or olecranon epiphyseal separation between 1992 and 2022, and were followed for more than one year postoperatively. Postoperative evaluation was conducted using the Conway-Jobe scale. Patients with olecranon osteophyte disorders and thoracic outlet syndrome were excluded. Surgical candidates were those who had persistent pain for more than three months with no evidence of bone union.Results:The OSF cases were classified as Physeal type (62 cases), Classical type (57 cases), Transitional type (21 cases), Sclerotic type (6 cases), and Distal type (11 cases). Surgical methods included inverted bone graft with TBW (62 cases), bone peg graft (78 cases), DTJ (6 cases), and drilling (1 case). According to the Conway-Jobe scale, 90.5% of cases achieved excellent or good outcomes, indicating very favorable postoperative results.Conclusions:In OSF surgery, we consistently use bone pegs and tailor the surgical method based on the fracture type. In cases of olecranon epiphyseal separation, we perform inverted bone grafting. We ensure that the bone peg is inserted perpendicular to the fracture line, with specific techniques depending on the fracture type: insertion from the ulnar bone peg harvest site for the Transitional type, and from the proximal ulnar side of the olecranon and the proximal ulna for the Classical and Distal types, respectively. Additionally, we use a 4.5 mm thick bone peg to maximize the contact area at the nonunion site and further promote bone union. In conclusion, we achieved excellent results in 90.5% of cases, demonstrating that OSF treatment using bone pegs is highly effective.

INTRODUCTION: Orthopedic trauma surgeons face major challenges when dealing with defect nonunions of the upper limb. In cases of treatment failure in forearm pseudarthroses, the incidence of secondary osteomyelitis and bone defects can reach 22% and 7%, respectively. The conventional approach, which includes surgical debridement of the bone cavity, single-stage grafting of the defect, and fragment fixation, is frequently ineffective. According to various authors worldwide, the Masquelet technique has demonstrated favorable outcomes with minimal complications. This method consists of two stages: first, a biological membrane is formed around the defect using a cement spacer; second, the spacer is replaced with an autologous bone graft after the membrane has formed. This technique has several advantages, including improved vascularization and favorable conditions for osteointegration. CASE DESCRIPTION: We present a successful case of surgical treatment in a patient with defect nonunion of the ulna and chronic osteomyelitis, following failed previous attempts at osteosynthesis and defect grafting. The first stage included modeling resection of the ulnar bone ends to bleeding surfaces, tunnelization, placement of a gentamicin-loaded spacer overlapping the fragment ends, and stabilization using an external fixation device. The second stage consisted of removing the external fixation device and cement spacer, autografting the defect zone with cancellous bone harvested from the iliac crest, closing the graft with the induced membrane, and osteosynthesis of the ulna using a locking compression plate (LCP). CONCLUSION: The Masquelet technique, when applied step by step in complex cases of forearm bone defect replacement, allows for the restoration of both the ulna and the anatomical and functional integrity of the forearm, improving limb function and facilitating the patient’s return to everyday life and work.

The paper presents an osteological study of the Posad necropolis of the ancient Russian city of Kursk of the 11th — 13th centuries. A total of 31 human skeletons were found, 20 of which belonged to adult individuals. The males and females of the group are characterized by an average and above average value of the intermembrane index, with slightly elongated upper limbs more common. Most males and females have an average or near average ratio of arm and leg segment lengths. The females are characterized by narrow shoulders and average pelvic width. The lifetime body length of men ranged from 155.9 cm to 174.7 cm, that is, men’s height ranged from small to large. The lifetime height of females ranged from 151.4 cm to 164.9 cm, that is, the height of women varied from below average to large. The bones of the arms and legs in the male sample are characterized by an average and high degree of massiveness. In in the female sample, the clavicles and ulna bones are different in terms of massiveness — the humeri are either medium massive or gracile, while the radii are medium massive, highly massive or ultramassive. The leg bones are of medium to high massiveness. Both male and female samples are characterized by strong sagittal flattening and notable development of the interosseous edge of the radii, weak sagittal flattening of the ulnae, and strong transverse flattening of the tibiae. In most males and females, the ulnae in the upper part of the diaphysis are moderately wide or eurolenic. In most males, the diaphysis of the femoral bones is narrow in the middle, some have a poorly or moderately developed bone pilaster. The femoral bones of females are characterized by both an expanded and narrowed diaphysis in the middle part of the shaft. The posterior bone pilaster is poorly developed in all females. More than 50% of men have a flattened and strongly flattened diaphysis of the femoral bones in the upper part. In most females, the diaphysis of the femoral bones is very flattened and hyperplatimeric. Both males and females are characterized by mesoknemic, or moderately dilated in the upper part, tibia.

Fractures of the distal radius often require surgical intervention, with plate fixation being a standard stabilization method. Screw loosening and pull-out propose significant complications, necessitating comprehensive understanding of fixation stability factors. This study introduces a novel approach by the combination of finite element analysis (FEA) and experimental investigations on Thiel cadavers to evaluate screw pull-out behavior from plate fixation in en bloc distal radius resection with ulnar reconstruction. In comparison with previous investigations that used computational modeling or fresh-frozen cadaveric specimens, in the present research, FEA predictions specifically experimentally confirm the usage of Thiel cadavers, which better preserve soft tissue elasticity and hydration, thus more closely reflect in vivo conditions. Experimental set-up consisted of bending tests on cadavers and screw pull-out tests in Thiel-cadaveric radius specimens mimicking physiological conditions that induce the effects of screw pull-out. Finite element analysis and simulation were conducted using realistic clinical cases. Biomechanical test results indicated locking-plate deformation and screw loosening, particularly at locations closest to the ulnar bone gap. Torque measurements established various degrees of screw loosening, with the screws closest to the bone gap indicating maximum loosening. FEA demonstrated critical distributions of stresses in screws and locking plates, with good correlations to experimental findings. Screw pull-out force analysis showed vulnerability to loosening, particularly in the area of bone gaps, with findings consistent between biomechanical testing and FEA. This study offers valuable information on the surgical implications and biomechanical considerations of plate fixation for en bloc distal radius resection with ulnar reconstruction.

To compare augmented reality (AR) and classical intraoperative C-arm surgical navigation and evaluate whether head-mounted display improves surgical accuracy in the placement of a rod-like object, such as K-wire, using an anatomically accurate elbow phantom. Data were collected between January 10, 2024, and March 15, 2024. We developed an AR system, X-ray simulation system and surgical phantom to test K-wire placement in 3 locations of the distal humerus and proximal ulnar bones. An initial phase with only X-ray as guidance was performed as case control; in later phases, the candidates were allowed to also use the head-mounted display. The evaluation parameters were time, placement angle, number of X-ray images taken, number of attempts, and distance from anatomical structures. In total, 19 physicians participated in the study. We analyzed 193 K-wire placements attempts that resulted in 150 estimated correct positions. This reflects a real-world scenario where multiple placements might be attempted to correctly place a K-wire. Compared with standard procedure, the use of AR resulted in -53.8 seconds in K-wire placement time, -47% of angular error from the K-wire target, -80% X-ray images taken to reach the estimate correct position, and decrease in distance variability of -81%, of the K-wire from anatomical structures of interest. Compared with C-arm, AR navigation improved time, and angle of placement, requiring less X-ray images.

Background. Malignant tumors of the forearm bones are rare, and remain a problem for orthopedic oncologists. Our study reports on benign locally aggressive and malignant tumors of the forearm bones, and various strategies for surgical removal of tumors, and bone reconstruction techniques. The choice of surgical intervention in case of the diseased forearm bones is determined not only by the degree of bone destruction by the tumor and the nosological entity of the neoplastic process, but also by the ability of the tumor to recur and metastasize. An analysis of the functional and oncological results of the upper limb after comprehensive and multimodal treatment of tumors of the forearm bones was conducted. Purpose. to show the effectiveness of multimodal and comprehensive treatment of benign locally aggressive and malignant tumors of the forearm bones. Materials and methods. Patients (n = 27) with tumors of the forearm bones were under our observation. There were 17 (62.9 %) patients with radial bone tumors and 10 (37.1 %) patients with ulna tumors, 16 (59.2 %) patients had giant cell tumor of bone, while 11 (40.8 %) had malignant tumors. The average follow-up lasted 27 (range 6 to 42) months. All 27 patients underwent surgical interventions within multimodal and comprehensive treatment regimens. Radial bone resection was performed in 17 patients, at that, most often of distal segment (13 patients), of proximal segment (3 patients), and of diaphysis of bone (1 patient). Ulnar bone resection was performed in 10 patients, at that, most often of proximal ulna (5 patients), of distal ulna (3 patients), and of diaphysis of bone (2 patients). The surgical margin of the tumor, after resection of the bone with the tumor, during morphological examination were along the edge of the lesion in 2 patients. Results. Postoperative complications were observed in 3 (11.1 %) patients. Functionality results of the upper limb after organ sparing surgery for tumors of the forearm bones according to the MSTS scale were: after the elbow joint endoprosthesis replacement the function amounted to 74.8 %, after osteoplastic surgery of the proximal ulna using allograft and ceramic material based on Bioactive Glass, the function of the elbow joint amounted to 96.6 %. After resection of the ulna diaphysis, and effecting reinforced metallic osteosynthesis, it amounted to 94.5 %. After resection of the distal ulna with the tumor, the function of the radiocarpal joint amounted to 80.4 %. After resection of the distal radius with tumor, and effecting fibular bone grafting, the function of the radiocarpal joint amounted to 88.3 %. After resection of the distal radius with tumor, and effecting endoprosthesis replacement using a metal-cement implant, the function of the radiocarpal joint amounted to 84.2 %. After resection of the proximal segment of radius with tumor, the function of the upper limb amounted to 78.5 %. After resection of the radial diaphysis, and effecting reinforced metallic osteosynthesis, the function of the limb amounted to 98.4 %. Oncological results: local tumor recurrence was observed in 3 patients (11.1 %), distant metastases were observed in 2 patients (7.4 %). Three-year overall survival of patients amounted to 82.4 ± 7.6 %, three-year recurrence-free survival amounted to 76.6 ± 8.5 %. Conclusions. Bone tumor recurrence is associated with inadequate tumor response to preoperative courses of polychemotherapy and radiotherapy, as well as with non-radical tumor removal (failure to adhere to surgical tumor margins during bone resection). Distant metastases represent a consequence of tumor recurrence after comprehensive and multimodal treatment, and are an adverse prognostic factor for patient survival.

Distal radius fracture nonunion can result in significant deformity, loss of function, and chronic pain. Presented here is a case of distal radius nonunion that was surgically reconstructed with a pedicled distal ulna bone graft based on the periosteal branches of the posterior interosseus artery (PIA). This technique has limited prior utilization for adult distal radius nonunion treatment but offers an effective option for surgical reconstruction of distal radius nonunion with preservation of the radiocarpal joint, utilizing a less invasive surgery that also reduces hospitalization stay. The objective of this report is to provide the first illustrative step-by-step surgical technique for the vascularized distal ulnar bone graft technique and demonstrate its promising utility in clinical practice.

Ulnar variance is a relative length difference in the wrist between the ulna and radius bones. It is a critical factor in helping to diagnose wrist disorders. The typical standard classification of length difference (ulnar variance) is divided into three major types: positive ulnar variance, negative ulnar variance, and neutral ulnar variance. Conventional or manual methods of measuring ulnar variance are long and time-consuming. With the urgent need for high efficiency and high speed, achieving more accurate diagnoses has become essential. In this paper, a deep learning-based methodology is used to automatically detect ulnar variance from radiographic images. Advanced Convolutional Neural Networks are exploited instead of traditional manual methods. Specifically, U-Net is used in the segmentation of ulna and radius bones, while DenseNets are applied to classify the type of ulnar variance. The essential contribution of this work is collecting a dataset of fully annotated wrist radiographs that are specific to this topic, which can be used as a resource to train and validate our models. Another contribution of this paper is optimizing the DenseNets model's hyperparameters to enhance its performance. Our model achieved a segmentation accuracy of 97.7% and an ulna variance classification accuracy of 92.1%. It outperformed previous deep learning-based methods in automatically segmenting the ulna and radius. This advancement not only reduces diagnosis time but also improves result reliability.

IntroductionHemophilia A is a rare inherited bleeding disorder. Less than 1% of FVIII level in plasma is classified as severe, 1%-5% as moderate, and above 5% as mild disease. The aim of this study is to share clinical and surgical experiences in Hemophilia A with extended half-life (EHL) recombinant FVIII preparations.Material and MethodsA retrospective observational study between 2024 and 2025, inpatient or outpatient follow-up was carried out in the Pediatric Hematology clinic of our university hospital. A total of 18 patients diagnosed with severe FVIII deficiency were included in this study.ResultsThe average age of the patients was 8.4 years (min. 20 months-max. 17 years). All patients were male and inhibitor negative severe FVIII deficiecy patients. Patients were numbered as P1-18 respectively. P1, P4, and P8 are 20 months, 3 years, and 4 years old respectively. They were evaluated as previously untreated patients (PUP) with a new diagnosis of severe FVIII deficiency and the other patients were previously treated patients (PTPs). P10 had 2 infected decayed molars and 1 incisor extracted in the same dental session. P13 underwent circumcision operation. P18 had refixation surgery due to a left arm radius and ulna bone fracture, and a cast was applied. All three surgical operations were performed under treatment of recombinant FVIII Efmoroctocog alfa (Ealfa/Elocta®) successfully.ConclusionEfmoroctocog alfa seems to be effective in EHL FVIII replacement therapy and surgical management of hemophilia A. Compared with standard half-life (SHL) FVIII products, EHL FVIII products such as Ealfa have the potential to optimize prophylactic outcomes by decreasing the burden of treatment or increasing the level of bleed protection.

The purpose of research is to study the structural features of the bones of the locomotor apparatus in the Asian (white-tailed) porcupine associated with plantigrade walking and living in thickets of vegetation. Objectives: to describe the structure and topography of the thoracic and pelvic limbs of the Asian (white-tailed) porcupine. The skeleton of the thoracic limb is represented by the scapula and the bones of the free part of the limb: humerus, radius and ulna, wrist, metacarpus and phalanges of the fingers. The skeleton of the pelvic limb is represented by the pelvic girdle and the free pelvic limb (femur, tibia, fibula, tarsus, metatarsus and phalanges of the fingers). The structure of the porcupine's limbs is determined by their lifestyle, with the hind limbs being columnar and the front limbs somewhat flattened, adapted for digging holes. Among other distinctive features of the skeleton, significant development of the bones of the thoracic and pelvic limbs is noted, which is due to a sedentary lifestyle. The structural features of the bones of the porcupine's limbs are that these bones are massive, but there are fewer bones of the wrist, metatarsus and phalanges of the fingers. This structure is typical for plantigrade animals that rely on their toes. The shoulder blade has a triangular shape, 10.5 cm long. The well-developed humerus reaches a length of 10.6 cm. The forearm is represented by the radius and ulna bones. The bones of the hand consist of the bones of the wrist, metacarpus and phalanges of the fingers. The wrist contains eight short, spongy bones arranged in two rows of four each. The four metacarpus bones are massive, long, and of equal length. The finger bones consist of four phalanges having three rows of bones. The bones of the pelvic girdle are formed by the ilium, pubis and ischium. The femur is massive, its length is 12.4 cm. The bones of the lower leg are represented by the tibia and fibula, equal in length. The tarsus is represented by three rows of bones, and there are five metatarsal bones.

Treatment of nonunion of the ulna and radius bone is a complex task. The most commonly used cortical osteosynthesis for this pathology has a number of significant disadvantages that can lead to delayed union, nonunion and infection. It compromises the result of reconstruction using cortical osteosynthesis plates with screws as a fixator. Thus, active rehabilitation treatment immediately after surgery is risky. Aim. The aim is to demonstrate the clinical observation of surgical treatment by an original method of a patient with nonunion of the ulna due to instability of cortical osteosynthesis. Materials and methods. Patient L. 18 years old. Diagnosis: pseudoarthrosis of the ulna. The condition after metal osteosynthesis is instability. Anamnesis. The patient had closed fracture of both forearm bones a year ago. The fractures were fixed with plates and screws. The fracture of the radius consolidated and osteosynthesis instability with the formation of a pseudoarthrosis occurred on the ulna. Analysing the X-ray data an angular deformation 100 was noted immediately after osteosynthesis. The ulna was reconstructed using a interlocking nail as a fixator and a bone grafting autograft from the ilium. Everyday load and rehabilitation were allowed immediately after the reconstruction. Result. The restructuring and assimilation of the autograft with fragments was noted after 12 months. The rotation function of the forearm was fully restored. The DASH score was 7.5. Conclusion. Thus, the application of the developed reconstruction method using a unterlocking nail as a fixator made it possible to carry out a rehabilitation course immediately after surgery without the risk of fixation failure.

Debridement, antibiotics, and implant retention (DAIR) is a well-described strategy for arthroplasty-related infections, resulting in good outcomes in selected cases. Fracture-related infection (FRI) poses a significant challenge to bone healing and the final outcome. FRI becomes a nagging problem for the treating physician and the patient alike. Various treatment modalities are described for the management of FRI, and one is selected based on the patient and disease characteristics. FRI in pediatric age is an uncommon entity. We hereby describe our case of an adolescent boy with FRI of the ulna bone in the setting of a well-fixed both-bone forearm fracture. FRI was successfully managed following the principle of DAIR with periodic debridement. Compliant follow-up and regular dressing can result in an uneventful healing of the FRI. DAIR can be a good option in an otherwise healthy pediatric case with implants in situ involving a segment of the forearm bone. A progressively encouraging result, following DAIR, should be checked before further continuation of the treatment. DAIR in selected cases, thus, is a viable option against FRI in pediatric forearm fractures.