Open Reduction and Internal Fixation of a Displaced Both-Bone Forearm Fracture in a Child Using Oversized Tubular Implants in a Resource-Limited Regional Hospital: A Case Report

Abstract

Introduction. Both-bone diaphyseal fractures of the forearm are among the most common injuries of childhood, and the majority are successfully managed by closed reduction and cast immobilisation. Operative fixation is reserved for irreducible, unstable, open, or markedly displaced fractures, and is favoured in older children whose capacity to remodel diaphyseal deformity is limited. In peripheral and regional hospitals the surgeon may face an additional, under-reported obstacle: an incomplete implant inventory that offers neither the ideal plate dimensions nor the full range of screw calibers.

Case presentation. We report a 12-year-old boy who sustained a closed, displaced fracture of the middle third of the left radius and ulna after a fall on the outstretched hand at school. Examination demonstrated forearm deformity, swelling, tenderness and crepitus, with an intact distal neurovascular status. Radiographs confirmed displaced both-bone diaphyseal fractures with angulation. Because the only implants available in the regional setting were relatively oversized tubular plates and a limited selection of screws, the operating surgeon adapted the technique while preserving the principles of anatomical reduction and stable fixation, performing open reduction and internal fixation of both bones. The postoperative course was uneventful; serial radiographs showed progressive consolidation, and the implants were electively removed at twelve months, revealing united bone without refracture.

Conclusion. Open reduction and internal fixation can achieve anatomical union of a paediatric both-bone forearm fracture even when only suboptimal implants are available, provided reduction quality and construct stability are respected. Adaptive surgical judgement is central to safe orthopaedic practice in resource-limited regional settings.