Conservative treatment for refracture of the forearm with elastic stable intramedullary nails in situ in an adolescent: A case report

Elastic stable intramedullary nailing (ESIN) for forearm shaft fractures in children and adolescents is generally associated with favorable outcomes. However, refracture with ESINs in situ is a rare complication. We report a rare case of refracture with implants in situ in a 14-year-old male patient. Six months after the initial surgery, the patient sustained a reinjury while playing soccer. Radiographs confirmed forearm shaft refracture of both the radius and ulna, and both intramedullary nails were bent at the fracture sites but remained unbroken. We performed emergent closed manual reduction after an ultrasound-guided axillary nerve block and successfully realigned the fractures and straightened the intramedullary nails without breakage. Although exchanging the ESINs was proposed, the patient and his family declined surgery, leading to conservative therapy. Bone union was achieved 2 months after refracture, resulting in a favorable outcome. This minimally invasive treatment is a useful first-line option because it requires no new implants and can be performed in emergency departments or outpatient settings. To our knowledge, this is the first report of this specific treatment in East Asian populations.