Childhood nonunion of ulna presenting with wrist deformity in an adult: a case report.
We describe an adult patient with traumatic, nonunion of ulna sustained at 11 years of age who presented with wrist deformity. The possible pathogenesis, differential diagnoses and its successful management are described. A 23-year- old right hand dominant male presented with a progressive wrist deformity of his right upper limb. At 11 years of age, he sustained an isolated open fracture of the right forearm. He had nonoperative treatment. He had 60 degrees of ulnar deviation at wrist. He had no pain in the wrist or elbow. He was able to do all activities using his right upper limb. Radiograph revealed a nonunion of ulna in mid-shaft. The radius was bowed. Radiographs at the time of injury revealed a displaced both bones forearm fracture in mid-shaft. He underwent open reduction, internal fixation of ulna with bone grafting and a corrective osteotomy of the radius. The contracted Extensor carpi ulnaris was Z lengthened. Seven months postoperative, both the nonunion of ulna and radius osteotomy were consolidated. The wrist had no deformity. He had returned to preoperative activity level. Though nonunion is rare in pediatric forearm fractures, asymmetric bone and soft tissue growth can lead to deformities even in the absence of physeal injury. In addition to the standard treatment of nonunion, maintenance of the relative lengths of radius and ulna is essential, to obtain optimum function.
Nithyananth
Manasseh
M
Department of Orthopaedics and Accident Surgery Unit I and Spinal Disorders Unit, Christian Medical College, Vellore, India. manasseh@cmcvellore.ac.in
Cherian
Vinoo Mathew
VM
Amritanand
Rohit
R
Venkatesh
K
K
Lee
Vernon Neville
VN
Sundararaj
Gabriel David
GD
D000058:Accidental Falls; D000328:Adult; D001858:Bone Nails; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D003131:Combined Modality Therapy; D000013:Congenital Abnormalities; D005500:Follow-Up Studies; D005543:Forearm Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000628:therapy; D005599:Fractures, Ununited / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007085:Ilium / Q000637:transplantation; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D018570:Risk Assessment; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000628:therapy; D014955:Wrist Joint / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*