Neglected Monteggia Fracture-Dislocation in an 8-Year-Old Child with Posterior Interosseous Nerve Palsy: A Case...

Monteggia fracture-dislocations are rare in children can often go undiagnosed, especially when initial treatment is provided by non-specialists. Missed injuries can result in chronic instability, pain, and limited function of the elbow joint.

We report the case of an 8-year-old girl who sustained an injury to her left elbow after falling while escaping a monkey attack. She initially received only bandaging from a local practitioner and presented to us 1 month later with ongoing pain and restricted elbow movement with posterior interosseous nerve (PIN) palsy. Radiographs revealed a neglected Monteggia fracture-dislocation. She was treated surgically with ulnar osteotomy and fixation with a 3.5 mm dynamic compression plate without reduction of the Radial head. The radial head was found to be reduced after ulnar osteotomy and plate fixation. PIN was not explored. Over a 15-month follow-up, the fracture united well, the radial head remained anatomically positioned, and the patient regained a full range of motion without pain with complete recovery of PIN palsy.

This case highlights the potential for Monteggia lesions to be overlooked when not properly assessed at the time of injury. It underscores the importance of early diagnosis and appropriate orthopedic intervention to prevent long-term complications. Even in delayed cases, satisfactory outcomes can be achieved with timely surgical management.