A rare Monteggia type-I equivalent fracture in a child. A case report and review of the literature

Monteggia type-I equivalent fracture in a fourteen-month-old child: A case report

BACKGROUND

Monteggia and equivalent lesions are relatively rare but result in severe injuries in childhood, typically affecting children between 4 and 10 years old. The diagnosis and treatment of an equivalent Monteggia lesion is more complicated than those of a typical Monteggia fracture. This type of lesion may be challenging and may lead to serious complications if not treated properly. Pediatric Monteggia equivalent type I lesions have been reported in a few reports, all of which the patients were all over 4 years old.

CASE SUMMARY

A 14-mo-old boy was referred to our clinic after falling from his bed 10 d prior. With regard to the clinical examination, an obvious swollen and angular deformity was noted on his right forearm. Plain radiographs and reconstructed computed tomography scans showed a Monteggia type I fracture and dislocation. Magnetic resonance imaging (MRI) confirmed a type I Monteggia equivalent lesion consisting of ulnar fracture and Salter-Harris type I injury in the proximal radius. The radial head was still in the joint, and only the radial metaphysis was displaced anteriorly. Open reduction and pinning of both displaced radial and ulnar fractures achieved an excellent result with full function.

CONCLUSION

We recommend MRI examination or arthrography during reduction, especially if the secondary ossification center has not appeared.

Posterior interosseous nerve palsy associated with neglected pediatric Monteggia fracture-dislocation: A case report

INTRODUCTION

The main goal of the treatment is the anatomical reduction of the ulna fracture and the radial head dislocation in acute and chronic Monteggia cases. Acute pediatric Monteggia lesions are generally treated non-surgically; however, the treatment of chronic Monteggia is challenging. The aim of this article is to share our experiences about treatment of neglected Monteggia lesion.

PRESENTATION OF CASE

A 6-year-old girl who underwent a surgery in our clinic for a missed Bado type-III Monteggia fracture-dislocation of the right elbow with concomitant posterior interosseous nerve (PIN) palsy, which resolved spontaneously after the operation. The operation consisted of open reduction of the radial head, transverse ulnar osteotomy and fixation with an intramedullary Kirchner wire, and annular ligament repair without exploring PIN. The patient was seen in routine follow-up periods until the postoperative first year using plain radiographies. At 16th week follow-up, all functions of the PIN were returned. At first-year follow-up, full range of elbow motion was observed; plain radiographies showed radiocapitellar joint congruency, and Mayo Elbow Performance Index was one hundred.

DISCUSSION

Treatment planning for chronic, neglected or missed Monteggia fractures is challenging. There is no consensus about the definitive treatment in the literature.

CONCLUSION

We recommend anatomic and stable restoration of radiocapitellar joint by correcting ulna deformity. Radiocapitellar fixation and PIN exploration may not be necessary in all neglected Monteggia lesions.