NONUNION OF A D ISTAL RADIAL FRACTURE IN A HEALTHY CHILD

Nonunion of distal radial fractures in children are rare. We report a case of a closed distal radial fracture in a healthy child, which developed a nonunion following closed reduction and plaster immobilization. Journal of Hand Surgery (British and European Volume, 1997) 22B: 2:175-177 Nonunion of long bone fractures in children are rare. Rang (1983) states "nonunion is an adversary almost unknown to the children's orthopaedic surgeon." O'Brien (1991) in his discussion on distal radial fractures in children does not mention nonunion as a complication. CASE REPORT The patient was a healthy 10-year-old girl who fell from a trampoline sustaining a closed, displaced fracture of her left distal radial and ulnar metaphyses (Fig 1). She was treated with a closed reduction and plaster immobil-ization in a long arm cast. A satisfactory reduction was obtained (Fig 2). She had a previous undisplaced frac-ture of the same forearm 2 years previously which had healed uneventfully. She was otherwise healthy with no stigmata of neurofibromatosis nor a family history of any skeletal abnormalities. She failed to present for follow-up until 2 months later at which time there was clinical and radiological evidence of delayed union. The plaster cast had remained intact but was loose. She was referred to our unit 1 month later, after a further period of immobilization. The fracture site was tender, the wrist was stiff and in radial deviation. X-rays showed pseudarthrosis with marked sclerosis of the bone ends (Fig 3). One month later after further immobilization, an examination under anaesthetic showed persistent movement at the fracture site which was subsequently explored. At operation the bone ends were sclerotic and the fracture site contained granulation tissue. This was removed and the bone ends freshened. The defect was packed with autogenous, cancellous, iliac bone graft and the forearm immobilized in a plaster cast for 8 weeks. Four months postoperatively she was pain fre