A type IV Monteggia injury with a distal diaphyseal radius fracture in a child

Type III monteggia equivalent injury with compartment syndrome in an 8 year old child: A case report

A rare case of a type III Monteggia fracture equivalent with compartment syndrome is reported here. Literature is very scanty about this rare combination of injuries which we are discussing. Timely intervention can lead to a satisfactory outcome even in these complex injuries.

A Type III Monteggia Injury with Ipsilateral Fracture of the Distal Radius and Ulna in a Child: Case Report Followed for 21 Years

Bado type III Monteggia injuries complicated by ipsilateral forearm fractures are extremely rare. We report a case of a 6-year-old boy who sustained such an injury after falling from the top of a 3 m climbing pole. He was diagnosed with a Bado type III Monteggia fracture and forearm fractures. Manual reduction was attempted on the day of injury. However, because it was difficult to maintain the reduction of the radial head, open and percutaneous procedures were performed to reduce and fixate the fractures with Kirschner wires. The postoperative course was favorable. Twenty-one years later, the patient, now 27 years old, had no decreased range of joint motion or problems with activities of daily living. The fracture morphology observed in this case is rare, and this is the only case for which long-term follow-up has been carried out to adulthood.

A rare combination injury of type III Monteggia fracture dislocation and ipsilateral epiphyseal fracture of distal radius in children. Is there a probability of missing the Monteggia component?

Combined type III Monteggia fracture dislocation and ipsilateral distal radial epiphyseal fracture is a very rare injury. Because of difficulty in performing the proper clinical evaluation of a child in an acute injury state, one of the components of this combined injury may be missed. We report a ten-year-old male child with this kind of injury where the Monteggia lesion was initially missed at the emergency department. Later we found the combined epiphyseal fracture of distal radius and Monteggia lesion in the ipsilateral side of the same limb which was managed by closed reduction and K-wire fixation. Bony union as well as wrist and elbow motion was complete 3 months after surgical intervention.

Type-I monteggia with ipsilateral fracture of distal radius epiphyseal injury: A rare case report

Simultaneous Monteggia injuries of the elbow and ipsilateral fracture distal radius with epiphyseal injury both bone are a unique case. A unique case of a Type I Monteggia fracture equivalent with ipsilateral fracture distal radius with epiphyseal injury (Salter-Harris Type II) in a child is reported. We describe the management of this unique fracture and discuss the possible mechanism of injury. We have highlighted a rare combination of injuries. Early recognition and prompt surgical intervention can lead to a satisfactory outcome even in these complex injuries. Résumé Les traumatismes de Monteggia simultanés du coude et le rayon distal de fracture ipsilatérale avec lésion épiphysaire des deux os sont un cas unique. Un cas unique d'une fracture de Monteggia de type I avec un rayon distal de fracture ipsilatérale avec lésion épiphysaire (Salter-Harris Type II) chez un enfant est rapporté. Nous décrivons la gestion de cette fracture unique et discuter du mécanisme possible de la blessure. Nous avons mis en évidence une combinaison rare de blessures. Une reconnaissance précoce et une intervention chirurgicale rapide peuvent conduire à un résultat satisfaisant même dans ces blessures complexes.

Segmental forearm bone injuries in children: classification and treatment

Background

Fractures of the forearm bones in children are a very frequent injury, while segmental injuries of the forearm bones are very rare and have not been sufficiently examined. In this retrospective study, segmental injuries involving the radius, the ulna or both in children are classified and treatment outcome is presented.

Materials and methods

Bone injury included any type of fracture or dislocation; segmental bone injury indicated the occurrence of more than one traumatic injury throughout the whole extent of each forearm bone. A total of 17 patients with 22 segmental bone injuries were identified and classified. Of these injuries, 12 involved the radius and 10 the ulna. The mean age at the time of injury was 8.9 years (range 3–13). In all cases, conservative treatment was the first treatment option; in three cases, however, surgical treatment was necessary.

Results

All injuries were classified into five types using the new nomenclature. Patients were evaluated after an average follow-up of 10.4 years. Union was noted in all cases without any complications. The function results were rated as excellent in 15 cases and satisfactory in 2 cases.

Conclusions

An inclusive classification system for segmental injuries of the forearm bones in children is presented. The proposed classification is a practical and utilitarian scheme that classified the patients of this report as well as all case reports previously published in the literature. It revealed that a wide variety of segmental injuries may be diagnosed following forearm injuries in children. This report also provided useful information that may influence the treatment of these complex injuries indicating that conservative treatment may be considered the first treatment option, and that primary surgical treatment is not justified.

Level of evidence

Level V.

Surgical treatment of chronic Monteggia type I equivalent lesion in 11 year old: a rare case report

BACKGROUND

The treatment of an unrecognized Monteggia lesion continues to pose a therapeutic challenge, as evidenced by the variety of surgical techniques described. The purpose of this study is to report one such rare case and its surgical treatment.

CASE REPORT

Eleven-year-old girl presented to us with left elbow injury 6 weeks after fall. On examination, she had deformity and total restriction of elbow movements. X-ray showed upper third ulnar fracture with separation of radial head epiphysis suggesting Monteggia fracture type 1 equivalent. Ulnar osteotomy with plating and reduction of radial head separation with transcapitellar wire fixation was done. Above elbow cast given for 6 weeks.

RESULTS

At 1 year follow-up, patient had regained good range of motion of elbow and forearm with maintenance of radial head reduction.

CONCLUSION

This study stresses on the need of surgical treatment in treating chronic Monteggia fractures. In best hands, it gives excellent results.

Monteggia Type IV Equivalent Injury

Equivalent lesions of Monteggia type IV injury have not appeared so far in the literature. Two Monteggia type IV equivalent lesions, which included a fracture of the radial head associated with midshaft fractures of the radius and ulna in a 3- and in a 12-year-old girl, are reported. The lesion presented in this report could be considered as a missing piece in the puzzle of Monteggia and equivalent injuries, and it could also add towards considering type IV injury as a primary lesion and not as a variant of type I injury.

Simultaneous monteggia type I fracture equivalent with ipsilateral fracture of the distal radius and ulna in a child: a case report

INTRODUCTION

Simultaneous Monteggia injuries of the elbow and ipsilateral distal radius and ulna fractures are very rare.

CASE PRESENTATION

A unique case of a type I Monteggia fracture equivalent with ipsilateral fracture of the distal radius and ulna (Salter-Harris type II) in a child is reported. We describe the management of this unique fracture and discuss the possible mechanism of injury.

CONCLUSION

We have highlighted a rare combination of injuries. Early recognition and prompt surgical intervention can lead to a satisfactory outcome even in these complex injuries.

Pathology of the annular ligament in paediatric Monteggia fractures

OBJECTIVES

To report our operative findings regarding the annular ligament in paediatric Monteggia fractures and to propose treatment recommendation for Monteggia fracture.

PATIENTS AND METHODS

A total of 35 children with type I and type III Monteggia fractures were treated operatively. The radial heads were all explored surgically in this series. The interposed ligament was stretched out of the joint space and was reduced around the radial head. In some of the patients, the joint capsule was repaired. Sixteen ulnar fractures were managed with open reduction and wire fixation, and 13 broken ulnas were fixed by plating. Six ulnar fractures were greenstick type and were treated by closed reduction and external fixation.

RESULTS

All the patients were functionally excellent at the 6-month follow-up in terms of bone healing and the range of motion of the elbow joint. No redislocation or subluxation of the radial head was found until in the last follow-up. No heterotropic ossification was observed in any follow-up radiographs.

CONCLUSIONS

The annular ligaments were intact in all paediatric patients with type I and type III Monteggia fractures and the ruptures were transversely on the joint capsule at the lower margin of the ligament. Most of the annular ligaments were interposed in the radiohumeral joint even though the radiographs showed reduction of the radial heads. We recommend reduction of the annular ligament in paediatric patients with Monteggia fractures.

Three epiphyseal fractures (distal radius and ulna and proximal radius) and a diaphyseal ulnar fracture in a seven-year-old child's forearm

SUMMARY

The authors report a rare case of fracture separations at both ends of the radius combined with an epiphyseal and diaphyseal fracture of the ipsilateral ulna. A seven-year-old girl fell one story and sustained a closed injury of her forearm. A closed reduction was unsuccessful, and an open reduction was performed with three of the four fractures being secured with Kirschner wires. These wires were removed one month later, and range-of-motion exercises were started. Thirty months after surgery, both forearms were equal in length, although the proximal radial epiphyseal line appeared partially closed. Joint motions, including forearm rotation, were normal. Radiologically, the ulnar diaphysis and the radial neck were posteriorly convex 20 degrees and 18 degrees, respectively.