Radiocapitellar Alignment in Suspected Pediatric Monteggia Lesions: Narrative Review and Imaging Interpretation...

Area of Science:

• Pediatric Radiology
• Orthopedic Imaging
• Skeletal Development

Background:

• Pediatric Monteggia fracture-dislocations are often subtle and challenging to diagnose.
• Incomplete ossification and non-standard imaging projections complicate radiographic interpretation.
• Existing alignment assessment methods may not be universally applicable across pediatric age groups.

Purpose of the Study:

• To synthesize evidence on radiocapitellar alignment assessment in pediatric Monteggia lesions.
• To propose a practical imaging interpretation framework for radiographs and advanced imaging modalities.
• To enhance diagnostic accuracy and communication for suspected pediatric Monteggia fractures.

Main Methods:

• Narrative review of clinically relevant evidence.
• Integration of developmental anatomy and radiographic adequacy.
• Evaluation of radiocapitellar line, P-line, lateral humeral line, and ulnar bow sign.
• Consideration of advanced imaging like ultrasound, MRI, and arthrography.

Main Results:

• A three-step framework for assessing radiocapitellar alignment is proposed.
• The framework guides image adequacy evaluation, line/sign selection, and interpretation of equivocal findings.
• Diagnostic error considerations and structured reporting are summarized.

Conclusions:

• The proposed framework aims to standardize radiologic reasoning for pediatric Monteggia fractures.
• It supports consistent communication among emergency physicians, radiologists, and orthopedic surgeons.
• Further validation through prospective studies is recommended before clinical pathway implementation.