Type III Monteggia fracture with posterior interosseous nerve injury in a child

Abstract

Rationale:Elbow injury in children by improper treatment or a delay of more than 3 weeks could lead to old unreduced Monteggia fracture, which are difficult to manage. Conservative or normal surgical methods usually fail.Patient concerns:Herein, we present a 6-year-old boy with sustaining injury approximately 1 month to his left elbow. Activity in his elbow was restricted, and his ability to extend his wrist and fingers was impaired.Diagnoses:Type III Monteggia elbow fracture-dislocation consisting of radial head dislocation and malunion of the ulna associated with posterior interosseous nerve palsy were confirmed, which requiring surgical treatment.Interventions:A closed reduction was performed with hyperplastic scar tissues erased and the radial head relocated.Outcomes:Follow-up 4 months later showed satisfactory recovery of function.Lessons:Forearm fractures in children may be misjudged, and that early anatomical reduction rather than conservative treatment may be required.

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].…”

“…Due to the lack of treatment guidelines for extra-articular Monteggia type III fractures, this study was performed on patients treated at four participating pediatric traumatology units in Germany. The study is small, with 26 cases, but its importance is highlighted by the comparison to only 32 patients described in the literature [2][3][4][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

“…In the case reports, 22 out of the 32 patients had normal results in the follow-up examination. Six patients showed residual axis errors of the ulna in X-ray images, which led to clinical abnormalities in four cases, such as restricted mobility and pain [12,14,20,24,25]. Three patients showed noteworthy results with restricted mobility; two of them had reduced pronation of 20° or 30°, with one child’s restriction attributed to an accompanying distal radius fracture [2,25,27].…”

“…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].…”

Current concepts in diagnosis and management of common upper limb nerve injuries in children

“…Hirachi et al described a group of 17 irreducible radial head dislocations in Monteggia lesions, eight of which were associated with PIN palsy. Moreover, according to Wang et al, 17 type III Monteggia fracture dislocations are often complicated by PIN injury. In addition, in fractures that simultaneously involve the shafts of the radius and ulna, displacement of the radius may cause nerve stretching with a distraction force.…”