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A functional ‘three-joint limb’
  1. Jean-François Vigneau,
  2. Youri Yordanov,
  3. Gerald Kierzek,
  4. Roland Istria,
  5. Jean-Louis Pourriat
  1. Emergency Department, Hotel Dieu, Paris, France
  1. Correspondence to Dr Jean-François Vigneau, Emergency Department, Hotel Dieu, Paris, France; jfvigneau{at}

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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.

Figure 1

A “three-joint limb”



  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.