Conservative Management of a Forearm Refracture With the Titanium Elastic Nailing System (TENS) In Situ in a 14-Year-Old Male: A Case Report

This case report presents a 14-year-old male patient with a medical history of left nephrectomy for cystic nephroma and resolved hypertension, who sustained a right both-bone middle shaft forearm fracture while playing football. The injury was managed initially with manipulation under anesthesia, the insertion of the Titanium Elastic Nailing System (TENS), and the application of an above-elbow cast. Clinical and radiographic reviews confirmed fracture healing after seven weeks, allowing for cast removal and advising the patient to avoid contact sports. However, 10 weeks post-initial treatment, the patient experienced a refracture following another traumatic incident. The refracture was treated conservatively with a combination of above-elbow and below-elbow casts over six weeks. Regular follow-ups every two weeks indicated satisfactory progress, leading to the removal of the TENS approximately four and a half months post-refracture. Subsequent clinical and radiographic evaluations showed complete fracture healing, with the patient regaining a full range of motion and intact neurovascular status at the final follow-up. This case highlights the potential for successful conservative management of pediatric forearm refractures with intramedullary nails in situ.