Ulnar avascular necrosis? You be the judge

Posttraumatic diaphyseal malunions of paediatric forearm fractures are associated with a considerable decrease in functional capacity. Corrective osteotomy and plating may be indicated to retrieve normal function and decrease the pain of the forearm. We present a case of a patient with malunited forearm to be treated with a corrective osteotomy. Intraoperatively, however, we visualized a grossly osteonecrotic ulna. After we removed the tourniquet and drilled 3 holes into the bone and still appreciated no active bleeding, we decided to abort the ulna osteotomy. Subsequent bone biopsy and bone scan results returned at the one and a half year follow-up clinical visit revealed that the visual appearance of the bone was misleading; however we are unaware of this finding in the literature. It is our intention that this case report draws attention to this possible outcome secondary to paediatric both bone forearm fractures and provide information about a presumably rare case in hopes of quantifying this complication and determining the true incidence of an abnormal ulna appearance.