MONTEGGIA LESION IN A CHILD: VARIANT OF A BADO TYPE-IV LESION. A CASE REPORT

Abstract

Monteggia described a lesion that consisted of a fracture of the proximal third of the ulna and an anterior dislocation of the proximal end of the radius1. Bado, in a series of forty patients, found that the fracture and dislocation could be displaced in various directions; he modified the original definition of a Monteggia lesion to “a group of traumatic lesions having in common a dislocation of the radio-humero-ulnar joint, associated with a fracture of the ulna at various levels or with lesions at the wrist.”2 This is a case report of a four-year-old boy who sustained a Monteggia fracture-dislocation that was Bado2 type IV. The child had a posterolateral angulation deformity of the fracture of the ulna, posterolateral dislocation of the radial head, and a fracture of the middle third of the radial shaft. A four-year-old boy fell from a height of about ten feet (three meters) and sustained an injury of the right forearm. He had a severe posterolateral angular deformity in the proximal part of the forearm without any neurovascular deficit. Motion of the elbow and wrist was very painful and restricted. Roentgenograms showed a fracture of the proximal third of the ulna, with 55 degrees of lateral angulation on the anteroposterior roentgenogram and 30 degrees of posterior angulation on the lateral roentgenogram. The radial head was displaced posterolaterally, and there was a fracture through the middle third of the radial shaft (Fig. 1). In addition, at the site of the fracture, there was plastic deformation of the ulna in an anteromedial direction. Roentgenograms showing a Bado2 type-IV Monteggia lesion with posterolateral angulation of the ulna and posterolateral dislocation of the radial head. Two attempts at closed reduction with the patient under general anesthesia were unsuccessful. The angular deformity of the ulna …