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

Abstract

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.

Floating Forearm Injury: Monteggia Variant Fracture With an Ipsilateral Distal Radius and Ulna Fracture

“…Additionally, it is difficult to infer the mechanisms of double fracture, as in this case. We postulate that the most likely mechanism contributing to her injury is a fall on the outstretched hand with a pronated forearm and dorsiflexed wrist, resulting in fractures of the distal radius and ulna [ 7 , 8 ]. The impact of her fall was subsequently transmitted to the elbow, causing a fracture of the radial head and proximal ulna.…”

Bado III Monteggia in children – treatment options and outcome: an ultrasound control study

“…There are no guidelines for the treatment of extra-articular fractures of the proximal ulnar metaphysis with accompanying dislocation of the radial head in childhood (Bado III Monteggia lesion). This injury has also been poorly investigated in studies, with only case reports available on a total of 32 patients in the literature [2][3][4][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

“…Apart from some case reports in the literature, there is no study about the outcome of the treatment of extra-articular Bado type III Monteggia fracture-dislocations in children. After conducting a Medline search, we found a total of 32 pediatric patients with this kind of lesion in different case reports from 1960 to 2018 [1,3,4,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

“…These children were treated in various ways: with reduction without implants, by plate osteosynthesis [4], by K-wire osteosynthesis [14][15][16], by intramedullary nailing (TEN) [21], and by using a radiocapitellar wire [26].…”

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

“…The combination of a Monteggia injury with an additional injury such as an ipsilateral distal radius fracture is even more rare. After a thorough literature search, we identified only eight pediatric cases of Monteggia injury with ipsilateral forearm fracture on record [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] . As there has been no comprehensive review of these cases, the clinical features of patients with those double fractures remain uncertain.…”