PMC4292322_01
X-ray of forearm with wrist joint anteroposterior and lateral views showing (a) Nonunion distal radius with positive ulnar variance. (b) Post ulnar shortening
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F1
As the deformity gradually worsened, the child was taken to medical center 4 months after the injury where he was evaluated with radiographs and treated with distal ulnar shortening to correct the forearm deformity [Figure 1].
Radiograph of the right forearm anteroposterior and lateral views (a) showing distal radius portraying the nonunion with manus valgus deformity (b) close up view of same x-ray
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F2
Due to previous surgery the distal ulna had a nonunion with its epiphysis as well [Figure 2].
Magnetic resonance imaging (a) Coronal T2 fat suppression images showing the nonunion site at the right distal radius. (b) T1- weighted coronal image showing the distal radius nonunion
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F3
Magnetic resonance imaging (MRI) confirmed the diagnosis [Figure 3] and there were no signs of infection in MRI as well.
Computed tomogram showing distal radius (arrow) and ulna nonunion
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F4
Preoperative computed tomogram revealed the relative position of the fragments [Figure 4].
Postoperative radiographs of forearm and wrist anteroposterior and lateral views showing the minirail fixator on the distal radius and ulna and differential distraction in progress
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F5
The parents were taught to do differential distraction and at a rate of 2 mm/day on the radial side and 1 mm/day on the ulnar side from the next day [Figure 5].
Followup radiographs of forearm and wrist showing spontaneous union at the end of deformity correction in distal radius which was stabilized with Kirshner wire
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F6
The union site was reinforced with a Kirschner wire [Figure 6].
Radiograph at fixator removal depicting union at the fracture site
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F7
The fixator was removed along with the Kirschner wire after 3 weeks and a volar splint was used for another 3 weeks and active range of motion therapy was started [Figure 7].
Clinical photograph showing the range of motion and function at one year followup. Active supination and pronation in the right forearm (a and b). The child could grip a pen firmly and write legibly (c)
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F8
Forearm had a passive pronation of 50  and 80  supination [Figure 8].