Adult Bado type I Monteggia fracture dislocation: A case report

Fractures of the proximal ulnar shaft accompanied by dislocation of the radial head have been described as "Monteggia fracture-dislocations," since the early nineteenth century. In 1967 Bado further classified these Monteggia fractures into four subtypes, based largely on the direction of the radial head dislocation (Bado, 1967). Despite being frequently discussed in the literature, Monteggia fracture dislocations are rare and represent only 0.7% of elbow fracture-dislocations in adults (Papaioannou et al., 2018). In adults, Bado type I lesions, where the radial head is displaced anteriorly are rarer still, and few cases have been reported in the literature (Papaioannou et al., 2018; Suarez et al., 2016; Egol et al., 2005; Saidi et al., 2018; Wong et al., 2015).

We present here the case of a 55-year-old male presenting with a Bado type I Monteggia fracture dislocation, resulting from direct trauma to the posterior ulnar surface of his arm. He was treated with ORIF five days after the injury, and by hospital discharge had had 75% active range of motion of his elbow to flexion and extension.

We present this case of a rare adult fracture subtype with a unique mechanism to add to a paucity of existing literature on such cases and the approach to their care. These fracture-dislocations can be easy to miss because the radial dislocation can be subtle and overshadowed by the more obvious ulnar fracture. This case report hopes to contribute to the expedient recognition of this fracture dislocation syndrome, which is crucial to the preservation of range of motion and arm function for these patients.