Severe forearm deformity and instability after Monteggia fracture-dislocation: a case report

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Reconstructive Surgery

Background:

• Monteggia fracture-dislocation in adolescents can lead to significant forearm deformity and joint instability.
• Longstanding ulna nonunion following such injuries can cause severe growth disturbances and degenerative changes.
• Maintaining forearm motion while addressing instability is a critical challenge in treating these complex cases.

Observation:

• A 16-year-old male presented with a painful, deformed forearm due to a Monteggia fracture-dislocation sustained at age 11.
• Radiographic evaluation revealed ulna nonunion, radial head dislocation, and radiocapitellar joint degeneration.
• Despite the deformity, the patient maintained a relatively good range of motion.

Findings:

• Surgical correction of the deformity and stabilization of the ulna using a vascularized fibular graft were performed.
• Two years post-surgery, the patient exhibited restored forearm stability and a good range of motion.
• The patient reported increased grip strength and absence of pain following the intervention.

Implications:

• Vascularized fibular grafting is an effective technique for correcting severe forearm deformities secondary to Monteggia fracture-dislocation.
• This reconstructive approach can successfully restore function, stability, and pain relief in pediatric patients.
• The findings highlight the potential for improved long-term outcomes in complex upper extremity injuries through advanced surgical methods.