Severe Neurovascular Compromise Associated with Plastic Deformation of Ulna Elastic Nail Following Forearm Re-fracture

We present a case of periprosthetic re-fracture of the forearm in a child with previous intramedullary elastic nailing of the ulna and plate fixation of the radius for a both-bone forearm fracture. In-situ plastic deformation of the ulna elastic nail resulted in persistent angulation and subsequent severe neurovascular compromise. The angulation was resistant to emergent attempts at closed manipulation and therefore nail removal, open reduction, and internal fixation were performed. At final follow-up, fracture union was demonstrated and there was no residual neurological deficit.