Abstract
Monteggia fractures are rare in children, and subtle radial head dislocations, with minor plastic deformation of the ulna, may be missed in up to a third of cases. Complications of Monteggia fractures-dislocations include persistent radial head dislocation, forearm deformity, elbow stiffness, and nerve palsies at the time of presentation. An unusual case of median nerve palsy following elastic stable intramedullary nailing of a type I Monteggia lesion in a 6-year-old girl is presented, and we highlight that, although most nerve palsies associated with a Monteggia fracture-dislocations are treated expectantly in children, early intervention here probably provided the best outcome.
Highlights
Monteggia fractures are rare and account for 0.4% of all forearm fractures in children [1]
Monteggia fractures are rare in children, and subtle radial head dislocations, with minor plastic deformation of the ulna, may be missed in up to a third of cases
An unusual case of median nerve palsy following elastic stable intramedullary nailing of a type I Monteggia lesion in a 6-year-old girl is presented, and we highlight that, most nerve palsies associated with a Monteggia fracture-dislocations are treated expectantly in children, early intervention here probably provided the best outcome
Summary
Monteggia fractures are rare and account for 0.4% of all forearm fractures in children [1]. Bado type I Monteggia lesions, with the radial head dislocated anteriorly, are the commonest and account for up to seventy percent of these injuries in children. Complications of Monteggia fractures-dislocations include persistent radial head dislocation, forearm deformity, elbow stiffness, and nerve palsies at the time of presentation [2, 4,5,6,7]. We present a case of median nerve palsy following elastic stable intramedullary nailing (ESIN) of a type I Monteggia lesion in a 6-year-old girl. An intraoperative decision by the senior author was made not to manipulate and reduce the displaced ulna fragment as it did not interfere with forearm rotation and the potential for remodelling in this six-year-old child (Figure 2). The patient was discharged home the following day, comfortable and with no neurovascular deficit
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