Monteggia fracture combined with ipsilateral distal forearm fracture is a rare injury, for which the literature is limited.
The plate was removed 1 year after surgery ( Figure 1F). Following two months of functional exercise, the patient's forearm range of motion had returned to 90° pronation, 80° supination, and 110° movement of the right elbow (range: 0–110°) with a Broberg-Morrey score of 88 points. Dorsiflexion of the fingers had gradually recovered, and was fully restored after 2 months. The forearm could be pronated by 60°, or supinated by 50°, and ~60° of flexion or extension of the right elbow joint could be achieved (range: 60–120°). The plaster cast was removed in the outpatient treatment room after 4 weeks. After discharge, the patient was reexamined in the outpatient department. Following surgery, the forearm was immobilized with an above-elbow splint and the patient was discharged from hospital a week later. Intraoperative fluoroscopy indicated that the humeroradial joint was well-positioned, and dislocation of the radial head was corrected ( Figure 1E). The forearm was subsequently supinated and the elbow joint flexed to reduce the radial head. Following removal of the bone fragments, the fracture was fixed with a compression plate. A compressive comminuted fracture of the proximal ulna was observed. Intraoperative fluoroscopy demonstrated that the fractured end had been reduced correctly.Ī posterior median incision of the elbow joint was created to reduce the proximal ulnar fracture. The incarcerated soft tissue was reduced and the fractured end fixed with miniplates and screws.
#Surgery for monteggia fracture skin#
After separating the skin and fascia, layer by layer, the ends of the fracture were exposed. Briefly, two longitudinal skin incisions (~3cm in length) were created aseptically, with the fracture of the distal ulna and the radius at the center. Surgery was performed following brachial plexus anesthesia, in which the patient was placed in a supine position while a pneumatic tourniquet was utilized. Four days later, the patient underwent open reduction of the fracture with internal fixation. After reviewing additional X-rays, it was found that radial head dislocation remained, with poor alignment of the right forearm fracture reduction ( Figures 1C,D). Numbness in the right hand improved significantly after reduction, but dorsiflexion function was poor.
#Surgery for monteggia fracture manual#
Considering that the patient displayed symptoms of nerve compression, manual reduction was performed as quickly as possible, with the right elbow joint and forearm placed in a cast.
X-ray films indicated fractures of the distal ulna and radius and proximal ulna, with lateral dislocation of the radial head ( Figures 1A,B). The child was also unable to perform dorsiflexion of the right first to third fingers. A pulse from the radioulnar artery was palpable but the right wrist and elbow joints were clearly distorted and swollen, with painful and restricted movement. Three hours earlier, he had accidentally fallen 2 meters from a platform while playing. Case ReportĪ 9-year-old boy complained of pain and swelling with restricted mobility in his right forearm. The present article reports the case of a 9-year-old boy who was diagnosed with a Monteggia fracture (Bado type III) combined with a fracture of the ipsilateral forearm. However, ipsilateral elbow and wrist fractures are rare ( 4). Distal forearm fractures are one of the most common injuries in children, and its incidence is relatively high, accounting for approximately 32.9% of the fractures in children, with a peak incidence at 9.9 years of age ( 3). In pediatric patients, fractures surrounding the elbow and wrist joints are common. Although such fractures have become increasingly recognized in the orthopedics community, the fracture itself remains a challenging clinical phenomenon. Because of the high rate of misdiagnosis, the complex mechanism of injury and presentation of challenging complications, Monteggia fracture has been the focus of attention of researchers. Of these injuries, type I (59%) and type III (26%) are the most common. In 1967, Bado termed this type of injury a Monteggia fracture, with 4 classifications that depend on the direction of the dislocation of the radial head ( 2). It was first reported by Monteggia, an Italian surgeon in 1814. It is uncommon in children, accounting for only 0.4% of the fractures in childrens' forearms ( 1). A Monteggia fracture is one in which the upper third of the ulna breaks while simultaneously a dislocation of the radial head occurs, representing a combined injury.
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