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

Simultaneous ipsilateral Monteggia fracture-dislocation and distal radius fracture: A report of a pediatric case and review of the literature

We present the case of a 12-year- old boy who suffered from a combination of Monteggia fracture-dislocation along with ipsilateral distal radius fracture. The patient underwent closed reduction of the Monteggia lesion and the distal radius followed by percutaneous pinning. The postoperative course was satisfactory. Associated Monteggia fracture-dislocation and ipsilateral distal forearm fracture are rare. Our case and the literature review highlight the presence of common clinical features in pediatric patients with these particular injuries, including male dominance, age around 9 years, fall from a height, and lateral displacement of the dislocated radial head.

Type III Monteggia Injury With Ipsilateral Distal Forearm Fracture in a Child: A Case Report

Monteggia fracture refers to breakage of the upper third of the ulna combined with dislocation of the radial head. It often occurs in children and adolescents and represents a combined injury. Fracture of the distal forearm is among the most common trauma suffered by children. However, distal forearm fractures have rarely been reported as having an association with Monteggia fractures. We report on a 9-year-old boy diagnosed with a type III Monteggia fracture combined with a distal forearm fracture. He underwent surgery and received rehabilitation training 1 month later. He was followed-up for 1 year. The affected limb functioned well with no sign of radial head dislocation.

Concurrent Proximal Fractures Are Rare in Distal Forearm Fractures: A National Cross-sectional Study

INTRODUCTION

Distal forearm fractures (DFF) account for 1.5% of emergency department (ED) visits in the United States. Clinicians frequently obtain imaging above/below the location of injury to rule out additional injuries. We sought to determine the incidence of associated proximal fractures (APF) in the setting of DFF and to evaluate the imaging practices in a nationally representative sample of EDs.

METHODS

We queried the 2013 National Emergency Department Sample using International Classification of Diseases, 9th edition, diagnostic codes for DFF and APF. Current Procedural Technology codes identified associated imaging studies. We calculated national estimates using a weighted analysis of patient and hospital-level characteristics associated with APF and imaging practices. An analysis of costs estimated the financial impact of additional imaging in patients with DFF using Medicare reimbursement to approximate costs according to the 2018 Medicare Physician Fee Schedule.

RESULTS

In 2013, an estimated 297,755 ED visits (weighted) were associated with a DFF, of which 1.6% (4836 cases) had an APF. The incidence of APF was lower among females (odds ratio [OR] (0.76); 95% confidence interval [CI], 0.64-0.91) but higher in metropolitan teaching hospitals compared to metropolitan non-teaching hospitals (OR [2.39]; 95% CI, 1.43-3.99) and Level 1 trauma centers (OR [3.9]; 95%, 1.91-7.96) compared to non-trauma centers. Approximately 40% (n = 117,948) of those with only DFF received non-wrist radiographs and 19% (n = 55,236) underwent non-wrist/non-forearm imaging. Factors independently associated with additional imaging included gender, payer, patient and hospital rurality, hospital region, teaching status, ownership, and trauma center level. Nearly $3.6 million (2018 U.S. dollars) was spent on the aforementioned additional imaging.

CONCLUSION

Despite the frequency of proximal imaging in patients with DFF, the incidence of APF was low. Further study to identify risk factors for APF based on mechanism and physical examination factors may result in reduced imaging and decreased avoidable healthcare spending.

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.