• Emergency department

A 57-year-old homeless man presented to the emergency room for poor performance status.

In 2006, he suffered a closed right forearm fracture, treated by open reduction and internal fixation with two plates. Two weeks later, after another fall, he presented with a displacement of the initial forearm fracture, secondary to the bending of both plates. The patient was then operated for hardware removal, double intramedullary pinning and immobilisation with an above-elbow cast.

The patient did not attend his follow-up appointments, promptly removed his cast and a few weeks later proceeded to a self-removal of the pins, which, by then, had been protruding through the skin.

Currently, there is complete pseudo-arthrosis of the radius and ulna, resulting in a somewhat satisfactory range of motion (figure 1). Usually these non-unions are known for greatly impaired function.1 However, our patient considered his upper limb to be functional enough for his daily needs and declined any further orthopaedic or surgical treatment.

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Figure 1

A “three-joint limb”