Abstract

While several complications are described after intramedullary fixation using Titanium Elastic Nails (TEN) for pediatric forearm fractures, delayed union rates are reported to be around 4%. A 12-year-old patient, who underwent TEN after a forearm fracture, was recommended to have a secondary surgery due to nonunion at the ulna after 16 weeks of follow-up. Unfortunately, the existing callus formation was lost after the patient received a second blow during the preoperative preparation process. Moreover, the family refused the operation because of the fear of the COVID-19 pandemic. The patient’s family gave consent after 35 weeks, and the patient was taken under the operation. The complete union was achieved with a full range of motion after 6 months of follow-up. In conclusion, in pediatric forearm fractures, one should be careful about the delayed union, carry out close follow-up and thorough evaluation, and secondary surgery should not be avoided when necessary.

Keywords: COVID-19 pandemics, delayed union, Pediatric forearm fracture, re-fracture, TEN complications

Copyright and license

Copyright © 2023 The Author(s). This is an open-access article published by Bolu İzzet Baysal Training and Research Hospital under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Gencer B, Arslan MM, Doğan Ö. A pediatric forearm fracture case with delayed union, re-fracture, and COVID-19 pandemics-related surgical delay. Northwestern Med J. 2023;3(1):62-6. https://doi.org/10.54307/NWMJ.2023.80664

References

  1. Lee AK, Beck JD, Mirenda WM, Klena JC. Incidence and Risk Factors for Extensor Pollicis Longus Rupture in Elastic Stable Intramedullary Nailing of Pediatric Forearm Shaft Fractures. J Pediatr Orthop 2016; 36: 810-5. https://doi.org/10.1097/BPO.0000000000000568
  2. Caruso G, Caldari E, Sturla FD, Caldaria A, Re DL, Pagetti P, et al. Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature. Musculoskelet Surg 2021; 105(3): 225-34. https://doi.org/10.1007/s12306-020-00684-6
  3. Martus JE, Preston RK, Schoenecker JG, Lovejoy SA, Green NE, Mencio GA. Complications and outcomes of diaphyseal forearm fracture intramedullary nailing: a comparison of pediatric and adolescent age groups. J Pediatr Orthop 2013; 33(6): 598-607. https://doi.org/10.1097/BPO.0b013e3182a11d3b
  4. Yuan PS, Pring ME, Gaynor TP, Mubarak SJ, Newton PO. Compartment syndrome following intramedullary fixation of pediatric forearm fractures. J Pediatr Orthop 2004; 24(4): 370-5. https://doi.org/10.1097/01241398-200407000-00005
  5. Rodríguez-Merchán, EC. Pediatric Fractures of the Forearm. Clin Orthop Relat Res 2005; (432): 65-72. https://doi.org/10.1097/01.blo.0000156480.76450.04
  6. Tisosky AJ, Werger MM, McPartland TG, Bowe JA. The Factors Influencing the Refracture of Pediatric Forearms. J Pediatr Orthop 2015; 35(7): 677-81. https://doi.org/10.1097/BPO.0000000000000355
  7. Fernandez FF, Eberhardt O, Langendörfer M, Wirth T. Nonunion of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop B 2009; 18(6): 289-95. https://doi.org/10.1097/BPB.0b013e32832f5b20
  8. Porter SE, Booker GR, Parsell DE, Weber MD, Russell GV, Woodall J Jr, et al. Biomechanical analysis comparing titanium elastic nails with locked plating in two simulated pediatric femur fracture models. J Pediatr Orthop 2012; 32(6): 587-93. https://doi.org/10.1097/BPO.0b013e31824b7500
  9. Luo Y, Wang L, Zhao LH, Wang YC, Chen MJ, Wang S, et al. Elastic Stable Titanium Flexible Intramedullary Nails Versus Plates in Treating Low Grade Comminuted Femur Shaft Fractures in Children. Orthop Surg 2019; 11(4): 664-70. https://doi.org/10.1111/os.12514