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Type III Monteggia fracture with posterior interosseous nerve injury in a child: A case report
Jing Wang1, Min Chen, Jiang Du
1Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Insights
Delayed treatment of pediatric elbow fractures, like Monteggia fracture-dislocation, can lead to complications. Early surgical reduction offers better outcomes for these challenging pediatric forearm injuries.
Area of Science:
- Pediatric Orthopedics
- Pediatric Trauma Surgery
Background:
- Delayed management of pediatric elbow injuries can result in unreduced Monteggia fractures, proving difficult for standard treatments.
- Conservative or typical surgical interventions often fail in cases of delayed presentation.
Observation:
- A 6-year-old boy presented with a month-old left elbow injury, exhibiting restricted elbow motion and impaired wrist/finger extension.
- Diagnosis revealed a Type III Monteggia elbow fracture-dislocation with radial head dislocation, ulnar malunion, and posterior interosseous nerve palsy.
Findings:
- Surgical intervention involved closed reduction, removal of hyperplastic scar tissue, and radial head relocation.
- Post-operative follow-up at 4 months demonstrated a satisfactory functional recovery of the elbow.
Implications:
- Pediatric forearm fractures, particularly Monteggia injuries, may be misdiagnosed or undertreated.
- Timely anatomical reduction is crucial for successful management, potentially avoiding complications associated with delayed or conservative approaches.
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.
