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Abstract
Background: Displaced diaphyseal both-bone forearm fractures in adolescents aged 12 years and older have limited remodeling capacity, and anatomical reduction is generally recommended. In resource-limited regional hospitals, unavailability of pediatric low-profile plates and elastic nails may require adaptation of adult-sized implants.
Objective: To describe biomechanical adaptation, radial bow restoration, consolidation and post-removal refracture outcome of open reduction and internal fixation with contoured 3.5-mm one-third tubular plates in an adolescent forearm fracture.
Methods: This study describes a 12-year-old boy (26.0 kg; body mass index 13.65 kg/m²) with a closed, displaced mid-diaphyseal left both-bone fracture (AO/OTA 22-D/4.1) followed at eight time points over 13 months (February 2025 to March 2026) in Bontang, Indonesia. Two contoured 3.5-mm four-hole one-third tubular stainless-steel plates were fixed across eight cortices per bone. Serial goniometry, radial bow morphometry, union scores and functional recovery were summarized as percentage change from baseline.
Results: Preoperative radial sagittal angulation (38.0°), ulnar sagittal angulation (32.0°), radial translation (100.0%) and maximal radial bow (3.2% at 48.0% of radial length) were corrected to 2.0°, 1.5°, 0.0% and 7.1% at 61.2% on immediate postoperative radiographs. Four-cortex union (modified RUST 16/16; Lane–Sandhu 10/10) and a 168.0° pronation–supination arc (QuickDASH 0.0) were achieved by Month 12. Elective plate removal at 12 months showed united bone; at Month 13, the arc was 170.0° with no refracture.
Conclusion: In this patient, contoured one-third tubular plates with eight-cortex purchase per bone restored radial bow geometry and achieved union without refracture after removal; this option may be considered when pediatric implants are unavailable.
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