Abstract
BackgroundFractures of the proximal third of the ulna and radius with associated anterior radial head dislocation are uncommon in children. Early recognition and appropriate management are essential to prevent long-term consequences of loss of forearm rotation, cubitus valgus, elbow instability and chronic pain.Case presentationWe present the case of a 3-year-old Caucasian boy who attended the emergency department following an un-witnessed fall, resulting in right elbow and forearm pain, swelling and deformity. Clinical and radiological examination revealed a Monteggia type IV fracture-dislocation.The patient was treated with closed manipulation and percutaneous fixation of both bone forearm fractures with intra-medullary wires. After failed attempts at closed reduction, open reduction of the radial head was required.The block to reduction was due to a buttonholing of the radial head through the anterior joint capsule, with interposition of the capsule in the radiocapitellar joint. Subsequently, alignment was maintained with fracture healing. Follow-up at five months showed a full range of elbow movement with no adverse symptoms.ConclusionMonteggia lesions of the paediatric elbow, albeit uncommon, should be considered in all forearm fractures. Accurate reduction of the radiocapitellar joint is crucial to prevent significant long-term consequences and failed closed reduction requires open reduction. Here we have described the management of a rare type IV lesion in which there was buttonholing of the radial head through the anterior capsule, causing the radiocapitellar dislocation to be irreducible (even after fixation of the radial and ulnar fractures).
Highlights
Fractures of the proximal third of the ulna and radius with associated anterior radial head dislocation are uncommon in children
We have described the management of a rare type IV lesion in which there was buttonholing of the radial head through the anterior capsule, causing the radiocapitellar dislocation to be irreducible
We have described an unusual case of a Monteggia type IV lesion with radial head buttonholing through the anterior joint capsule
Summary
We have discussed a case of irreducible radial head dislocation following a Monteggia type IV lesion that required open reduction. These are uncommon but there are several learning points from this case: 1. Monteggia type lesions of the paediatric elbow should be considered in forearm fractures and initial assessment should include examination of the elbow and imaging where appropriate. What was unusual about this case, Consent Written informed consent was obtained from the patient’s legal guardian for publication of this case report and accompanying images. JSH conceived the idea for the report and TH and SJG drafted the manuscript. JSH and SJG granted final approval for the version to be published. All authors read and approved the final manuscript
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