PMC6742864_01
(a) X-ray of the right forearm at initial presentation t=0. (b) X-rays at planned follow-up 4 months later, t=4/12.
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F1
She was known to our unit having had sustained a mid-shaft both bone forearm fracture (Fig. 1a) which was subsequently treated with flexible IM titanium elastics nailing system (TENS) (IM, intramedullary; TENS DePuy Synthes) nails 5 months prior (Fig. 1b).
Clinical presentation after a second fall, 5 months post-initial fracture and elastic stable intramedullary nails (ESIN), corresponding to X-ray seen in Figure 2a, refracture with ESIN.
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F2
On presentation to ED, she had an obvious right upper limb deformity (Fig. 2) but denied pain.
(a) X-rays following second fall and representation 5 months after initial trauma, t=5/12. (b) X-rays showing position following manipulation under anesthesia and casting with elastic stable intramedullary nails in situ.
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F3
X-rays revealed a fracture through her previous fracture site (Fig. 3a). She was brought to theater and managed through a closed reduction under general anesthesia, correcting the angle of the IM nails until acceptable reduction was achieved (Fig. 3b).
(a) X-rays showing status of forearm at t=6/12 post refracture (and 11 months postinitial fracture). (b) X-rays post removal ofelastic stable intramedullary nails, t=7/12 postfracture (and 12 months post-initial fracture).
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F4
She went onto have an excellent recovery, routine follow-up in clinic allowing for confirmation of radiological and clinical fracture union (Fig. 4a). The IM nails were then removed 6 months following her refracture (11 months total in situ, Fig. 4b) and she has been since discharged well from our service.