PMC4719359_01
Radiograph of left forearm showing fracture of both bones of forearm at upper and middle third junction.
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F1
Radiography of left forearm revealed fracture of both bones of forearm at upper and middle third junction (Fig 1: Radiograph of left forearm showing fracture of both bones of forearm at upper and middle third junction).
Radiograph of left forearm after plaster slab application
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F2
Manipulative reduction and above elbow plaster slab application was done under sedation (Fig 2: Radiograph of left forearm after plaster slab application).
Clinical photograph and radiograph of left forearm showing atrophic non-union of upper and middle third junction of left ulna with malunion of left radius and Volkmann's sign.
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F3
Radiograph of forearm with wrist and hand revealed atrophic non-union of upper and middle third junction of left ulna and malunion of left radius with positive Volkmann's sign (flexion attitude of fingers with wrist in extension and the same getting corrected with the wrist in flexed position); (Fig 3: Clinical photograph and radiograph of left forearm showing atrophic non-union of upper and middle third junction of left ulna with malunion of left radius with Volkmann's sign).
Intra operative photograph showing radial shortening osteotomy fixed with dynamic compression plate and screws
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F4
The cut ends of the radius were approximated and fixed with small (3.5mm) dynamic compression plate and screws leading to a two and a half centimetre radial shortening (Fig 4: Intra operative photograph showing radial shortening osteotomy fixed with dynamic compression plate and screws).
Intra operative photograph showing radial tubular intercalary auto graft placed in the gap after the excision of non-union of ulna
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F5
The two and half centimetre radial tubular graft was used as intercalary sturt graft at ulnar gap non-union site and was fixed with a rush nail from the olecrenon (Fig 5: Intra operative photograph showing radial tubular intercalary autograft placed in the gap after the excision of non-union of ulna).
Post-operative radiograph of left forearm showing in-situ radial plate and rush nail in ulna holding the intercalary bone graft in place.
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F6
This has resulted in effective shortening of forearm by two and half centimetres to address the VIC component of the patient (Fig 6: Post operative radiograph of left forearm showing in situ radial plate and ulnar rush nail holding the intercalary bone graft in place).
Six weeks follow up post-operative radiograph of left forearm taken after the implant removal from ulna
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F7
The cast was found to be broken at the elbow with lagged out rush nail at 6 weeks follow up requiring implant removal. (Fig 7: Six weeks follow up post-operative radiograph of left forearm taken after the implant removal from ulna).
Ten weeks follow up post-operative radiograph showing union of radius and ulna
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F8
The radial osteotomy has united in six weeks and the ulnar intercalary graft site has united in ten weeks (Fig 8: Ten weeks follow up post operative radiograph showing union of radius and ulna).
Post-operative follow up clinical photograph of the patient showing absence of Volkmann's sign
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F9
Volkmann's sign was negative after the surgery till date (Fig 9: Post operative follow up clinical photograph of the patient showing absence of Volkmann's sign).
Three years follow up radiograph of left forearm after the radial implant removal showing consolidation and incorporation of intercalary tubular radial graft in the ulna
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F10
Three years following surgery, radial plate was removed owing to the patients request for implant removal (Fig 10: Three years follow up radiograph of left forearm after the radial implant removal showing consolidation and incorporation of intercalary tubular radial graft in the ulna).