Case Report: A Rare Variety of Type 4 Monteggia Fracture Dislocation in A 28 Years Old Man

Ranadeb Bandyopadhyay

doi:10.4236/ojo.2012.22009

Abstract

A Monteggia fracture is a fracture of the proximal ulna coupled with a radial head dislocation. Numerous classification systems have been developed to characterize these fractures. Bado classification is most commonly used. Bado type 1 Monteggia fractures are most common while type 3 & 4 are rare entities. In our case, after confirming the diagnosis as type 4 Bado Monteggia fracture dislocation, patient was posted for open reduction and internal fixation. The ulnar and radial fractures were rigidly fixed with 3.5 compression plate and ulnar length restored. However, the radial head was still found to be dislocated anteriorly on fluoroscopy. An attempt of closed reduction of the radial head failed. Open reduction of the radial head was performed under image intensifier and fixed with a Kirschner’s wire followed by immobilization in hyperflexion for 2 weeks. The patient followed up at the end of 2 weeks, 4 weeks and 6 weeks following injury and gradual mobilisation of the elbow joint was made. Further follow up at 6 months and 1 year showed complete return of routine function. As soon as the ulnar length is restored by rigid internal fixation, radial head is itself reduced in majority of Monteggia fracture dislocation where only ulnar fracture is involved. However, in cases of both bone forearm fracture with radial head dislocation, even after restoring the length of ulna and radius, operative reduction of radial head is essential.

Highlights

Fractures of the proximal ulna with a concomitant dislocation of the radial head are uncommon injuries that comprise 5% of all forearm fractures
A Monteggia fracture is a fracture of the proximal ulna coupled with a radial head dislocation
Bado type 1 Monteggia fractures are most common while type 3 & 4 are rare entities

Summary

Introduction

Fractures of the proximal ulna with a concomitant dislocation of the radial head are uncommon injuries that comprise 5% of all forearm fractures. A patient with these types of injuries will complain of pain around the elbow and mechanical block to elbow flexion and forearm rotation [1]. The combination of injuries known as Monteggia fracture-dislocation is an often treacherous condition to treat. The Monteggia fracture and its variant can be treated conservatively in children, but routinely requires open reducetion in adults. The goal of treatment of a Monteggia injury is rigid fixation of fractured ulna which relocates the dislocated radial head [3]. Any residual angulation of the ulna fracture predisposes to subsequent redislocation or subluxation of the radial head. In the adult patient open reduction and internal fixation should be used

Case Report

Findings

Discussion