Type III monteggia injury with ipsilateral type II Salter Harris injury of the distal radius and ulna in a child: a case report

Abstract

BackgroundAlthough previously reported, ipsilateral Monteggia fracture dislocation and distal radius fracture in a child is still a rare occurrence. A full clinical examination may be difficult but should not be ignored. Full length forearm radiographs are ideal but proper limb positioning may be difficult. The injury pattern can be easily missed.Case presentationA five-year- old right hand dominant Caucasian male presented with a history of fall on outstretched hand. Clinical examination was difficult and X - rays confirmed type III Monteggia fracture with an ipsilateral Type II Salter Harris injury of the distal radius and ulna.ConclusionThis report highlights the need for relevant examination of the wrist and elbow in young children. Appropriate radiographs must also be performed to prevent missing these injuries.

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

“…They found that only one out of 33 or 2 out of 102 patients with Monteggia fractures exhibit associated fractures [ 5 , 9 ]. To our knowledge, beyond these cases, only 3 cases of Monteggia fractures with ipsilateral fracture of the distal radius and ulna have been reported, as in the present case [ 10 – 12 ].…”

“…The observation period in all previous reports of Monteggia injury with ipsilateral forearm fractures has been 2 years or less [ 6 – 8 , 10 – 14 ], except for a 6-year follow-up reported by Biyani [ 1 ]. This is the only case wherein long-term postoperative follow-up evaluation was feasible until adulthood.…”

“…While treating a Monteggia fracture, examination of both the cubital joint and the wrist joint is important because a fracture of the distal forearm may also occur, as in this case [ 10 ]. Since a child who has sustained such an injury may be experiencing pain and/or anxiety and therefore unable to sufficiently express himself, the presence or absence of any swelling, deformities, abrasions possibly due to direct force, and ROM limitation should be carefully examined.…”

“…Since a child who has sustained such an injury may be experiencing pain and/or anxiety and therefore unable to sufficiently express himself, the presence or absence of any swelling, deformities, abrasions possibly due to direct force, and ROM limitation should be carefully examined. It is important to perform accurate radiography in 2 planes (i.e., frontal and lateral views) [ 6 , 10 ]. Since Monteggia fractures in children are mostly incomplete greenstick fractures, reduction and maintenance are easy to perform.…”

Unusual Monteggia type 1 variant in adult: a rare finding in a rare fracture

“…The diagnosis is often missed in the trauma and emergency department, necessitating a thorough clinical examination and radiographic interpretation 1. The injury has been described variously but Bado’s classification remains the most acceptable.…”