Monteggia equivalent lesion in children: a narrative review

Abstract

BackgroundMonteggia equivalent lesion represents a group of injury or combined injury patterns that resemble the Monteggia lesion in its presentations and mechanisms. Unlike Monteggia lesions, the equivalent ones, which share vague definitions and mostly occur as sporadic single case reports in the literature, have not been thoroughly reviewed since Bado first proposed the term, especially in the pediatric population. The objective of this review was to elucidate the definition by elaborating on its clinical styles and thus analyzing the mechanism, diagnosis, and management through related literature.Data sourcesBased on the terms of ‘Monteggia equivalent’, ‘radial neck fracture’ and ‘pediatric’, all of the related literature was searched on the PubMed and Google Scholar search engine.ResultsThe advance of the definitions for pediatric Monteggia equivalent lesion (PMEL) was reviewed. The functional roles of the ulnar and the related mechanism theories in this injury were analyzed. The status of the radiocapitellar joint in this injury was emphasized. According to the previous statements, a new classification model was proposed and proper diagnosis and treatment approaches were suggested.ConclusionsPMEL should be defined as an ulnar fracture at any level combined with a proximal radial fracture. According to the status of the radiocapitellar joint, it could be divided into three groups. The occult ulnar bowing and delayed radial head dislocation should be a serious concern of orthopedists. Surgical need is usually warranted. Maintaining the ulnar length and securing the radiocapitellar joint are highly recommended.

Case report: Pediatric floating elbow fracture with monteggia-equivalent lesion, ipsilateral humeral shaft fracture, and radial nerve injury: a unique case and favorable treatment outcomes

“…PMEL is often overlooked and mismanaged due to its unclear definition and diverse presentation. Xu et al suggest defining PMEL as an ulnar fracture at any level combined with a proximal radial fracture ( 5 ). They classify PMEL into three groups based on the radiocapitellar joint status: stable, unstable, and dislocated.…”