Monteggia variant with posterior elbow dislocation and radial shaft fracture: A case report

The most commonly used Bado classification encompasses the large majority of Monteggia fractures, however, certain patterns cannot be classified with this system. Monteggia injuries and Monteggia-Variants are uncommon but serious injuries that can have dire consequences if not identified and treated appropriately. This paper aims to review relevant literature, discuss current classification systems, and present a case of an atypical fracture pattern.

We present a case of a unique Monteggia variant in an adult that to our knowledge has not been discussed in the literature. The patient presented to the emergency department after a fall while skateboarding. Plain radiographs demonstrated a displaced proximal radial shaft fracture with posterior elbow dislocation and an intact ulna. The patient was closed reduced in the emergency department, and taken to the operating room thirteen days post injury. Open reduction internal fixation with compression plating of the radius was performed, and the patient was discharged home without complications.

As our knowledge of the forearm and forearm injury patterns has expanded, it has become increasingly clear that our current classification systems and algorithms may not suffice. Monteggia variants are difficult to diagnose, and they also portend to have poorer outcomes. It is to our knowledge that this unique Monteggia Variant has not been previously described.

The successful identification and classification of forearm fractures is vital to proper treatment. It is our hope that awareness of this Monteggia-variant contributes to the knowledge base of forearm fracture-dislocations and their treatment.