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Volar DRUJ Instability After Midshaft Both-Bone Forearm Fracture in a Toddler: A Case Report

T Hunter Stocker-Downing1, Francesco Biolzi, Frederick P O'Brien

  • 1Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia.

JBJS Case Connector
|November 19, 2021
PubMed

Insights

A pediatric wrist popping case highlights distal radioulnar joint instability after a healed both-bone forearm fracture (BBFF). Monitoring radius malunion is crucial for assessing functional recovery and remodeling in children.

Area of Science:

  • Pediatric Orthopedics
  • Pediatric Orthopedics
  • Pediatric Orthopedics

Background:

  • A 2.5-year-old male experienced left wrist popping after a closed left both-bone forearm fracture (BBFF).
  • The initial BBFF treatment involved reduction and casting, but redisplacement necessitated secondary manipulation and casting.
  • Osseous union was achieved, but a 20° apex volar malunion of the midshaft radius persisted.

Observation:

  • Parents reported audible wrist popping during active motion.
  • The popping was associated with a residual 20° apex volar malunion of the radius.
  • The child's treatment involved observation and monitoring of deformity remodeling.

Findings:

  • Distal radioulnar joint instability can occur as a complication of malunited BBFF in pediatric patients.
  • A residual radial malunion following BBFF can lead to symptomatic wrist instability.
  • Wrist popping in this case was attributed to the malunion and potential associated joint instability.

Implications:

  • Malunited BBFF, particularly with radial deformity, requires vigilant follow-up in pediatric patients.
  • Assessing functional recovery and monitoring deformity remodeling post-union are essential.
  • Early identification and management of residual deformities can prevent long-term complications like distal radioulnar joint instability.
Abstract

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