Type III monteggia injury with ipsilateral type II Salter Harris injury of the distal radius and ulna in a child: a case report

Huw Lm Williams,Thayur R Madhusudhan,Amit Sinha

doi:10.1186/1756-0500-7-156

Abstract

BackgroundAlthough previously reported, ipsilateral Monteggia fracture dislocation and distal radius fracture in a child is still a rare occurrence. A full clinical examination may be difficult but should not be ignored. Full length forearm radiographs are ideal but proper limb positioning may be difficult. The injury pattern can be easily missed.Case presentationA five-year- old right hand dominant Caucasian male presented with a history of fall on outstretched hand. Clinical examination was difficult and X - rays confirmed type III Monteggia fracture with an ipsilateral Type II Salter Harris injury of the distal radius and ulna.ConclusionThis report highlights the need for relevant examination of the wrist and elbow in young children. Appropriate radiographs must also be performed to prevent missing these injuries.

Highlights

Previously reported, ipsilateral Monteggia fracture dislocation and distal radius fracture in a child is still a rare occurrence
We report this rare injury with associated distal radius and ulna injury in the ipsilateral limb, the importance of a full thorough clinical examination and the need for full length radiographs in order not to miss this injury by the junior doctors in the emergency department
Unstable Monteggia fracture dislocation with ipsilateral distal radius fracture rare is possible in children

Summary

Background

Monteggia fracture patterns are rare in children and merits appropriate treatment to avoid late disability of the elbow and forearm. The injury pattern is missed initially or later if not followed up adequately Both operative and non operative treatment methods are described and are successful. The chosen method will be dictated by the injury pattern, associated skeletal injuries and the stability of reduction achieved intraoperatively We report this rare injury with associated distal radius and ulna injury in the ipsilateral limb, the importance of a full thorough clinical examination and the need for full length radiographs in order not to miss this injury by the junior doctors in the emergency department. The patient was monitored for compartment syndrome over the 24 hrs and was discharged when clinically safe He was followed up in clinic weekly for 3 weeks, with serial radiographs of the forearm. Follow up radiological images showed all fractures had healed (Figures 6 and 7)

Findings

Discussion

Conclusion