Neglected anterior monteggia lesion with a displaced intra-articular medial condyle fracture in a child: A rare and challenging association

Abstract

Monteggia fracture dislocation refers to a dislocation of the proximal radioulnar joint together with an ulnar fracture. Bado described four types of Monteggia lesions. Type I is the most common, where the radial head is dislocated anteriorly. Misdiagnosis of pediatric Monteggia fracture dislocations is fraught with potentially serious functional complications and treatment challenges. This is especially true in the event of late presentation and association with a simultaneous ipsilateral skeletal comorbidity. We present the case of a child with an extremely rare neglected type I Monteggia fracture dislocation associated with a displaced intra-articular medial humeral condyle fracture. We aim to demonstrate the radioclinical outcome of surgical management of this child and to offer possible mechanisms of injury found upon fracture characteristics and biomechanics. The patient was managed by a characteristic open surgical technique that offered satisfactory functional and radiologic outcomes on the short-term despite late presentation. We established correlations between the proposed injury mechanism, imaging abnormalities, and intraoperative findings that aided in management implementation.