title: Nonunion in a distal radius metaphyseal fracture in a child: Role of intact periosteal sleeve in management.
abstract: We present an adolescent with distal radius nonunion following an open fracture and failed surgery which eventually united when the length and stability was restored for eight weeks duration. The intact periosteal sleeve at the nonunion site formed new bone when its tension was restored by gradual differential distraction. This case report highlights the possibility of stimulating bony union in an established atrophic nonunion by distracting the minimally disturbed soft tissue and thick osteogenic periosteal envelope in the paediatric age group.
authors.affiliation: Department of Trauma and Orthopaedics, B M Orthopaedic Hospital, Chennai, India.
authors.forename: Raju
authors.initials: R
authors.lastname: Sivashanmugam
authors.affiliation: Orthopaedic Unit, Child Trust Hospital, Chennai, Tamil Nadu, India.
authors.forename: Sriram
authors.initials: S
authors.lastname: Vijay
authors.affiliation: Department of Orthopaedics, Sheffield Childrens Hospital, Western Bank, Sheffield, S10 2TH, United Kingdom.
authors.forename: Balasubramanian
authors.initials: B
authors.lastname: Balakumar
keywords: Distal radius; Fractures ununited; atrophic; compound; distraction; nonunion; open fracture; osteogenic; pediatric; periosteum; radius fractures