Treatment of Monteggia-like-lesion in a young patient

Abstract

Introduction: A Monteggia fracture was described initially as a fracture of the proximal third ulna and anterior dislocation of the proximal epiphysis radius. [ 1 ] In 1967, Bado discovered “true Monteggia lesions” and classified them into 4 groups. [ 2 ] He also used the term “equivalents” or “Monteggia-like-lesions” to describe specific injuries with similar radiographic patterns. [ 3 ] This type of fracture is rare and frequently associated with complications, poor functional results, and further operations. [ 4 ] Patient concerns: A 16-year-old girl was admitted to our emergency department after a single motorcycle accident. Her main complaint was the pain and swollen of her left elbow. She was reluctant to move her arm due to pain. Diagnosis: Radiograph examination showed a displaced fracture of the left proximal third ulna accompanied by displacement of the left proximal radius. This fracture was similar to the Monteggia type III fracture except for proximal radial disruption that occurred laterally through a Salter-Harris type II fracture. Interventions: The patient underwent surgical debridement, and the forearm was immobilized using a backslap in a supine position and elbow flexion 90 o . Open reduction and internal fixation were performed 5 days later. The ulna was reduced and stabilized first using a 3.5 mm one-third tubular plate (ORMED), and internal fixation of the radial epiphysis was done using a 1.6 mm miniplate (Prohealth). Outcomes: After 3 months, the patient showed improvement with the Mayo Elbow Performance Score (MEPS) of 85. She did not complain of any pain and decreased strength. The patient regained 0 to 125 o of elbow flexion and 0 to 165 o of supination and pronation. Conclusion: Monteggia-like-lesion has many variations in physical and radiograph appearance. Careful evaluation of fracture pattern, identification of injury mechanism, and appropriate treatment planning based on Monteggia fracture treatment principles are mandatory to achieve the patient's best outcome.