Management of Paediatric Monteggia Variant Fracture – Our Experience of Two Similar Cases
Volume 9 | Issue 2 | May-August 2023 | Page: 30-33 | Ramani Narasimhan, Vaibhav Gautam
DOI- https://doi.org/10.13107/ijpo.2023.v09.i02.169
Submitted: 13/05/2023; Reviewed: 09/06/2023; Accepted: 21/07/2023; Published: 10/08/2023
Authors: Ramani Narasimhan MS Ortho Fellow Paediatric Orthopaedic Surgey (USA) , Vaibhav Gautam MS Ortho
[1] Department of Paediatric Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India.
Address of Correspondence
Dr. Vaibhav Gautam,
Department of Paediatric Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India.
E-mail: vaibhavgtm1@gmail.com
Abstract
Introduction: The common mechanism of injury for Monteggia fracture is fall on outstretched hand with elbow extended and forearm in pronation causing a proximal fracture of ulna with dislocation of radial head. Monteggia injuries were classified by Bado into 4 sub-types based on the direction of displacement of the radial head and the presence of associated fracture (type 1 with anterior dislocation of radial head being most common). We managed two cases of Monteggia type 1 variant injury consisting of a fracture of the radial neck and anterior displacement of distal radial shaft without dislocation of the radiocapitellar joint.
Case report: We operated two children (5 and 9 years old respectively) with this Monteggia variant injury; displaced ulna shaft fracture with volar angulation, and fracture neck radius with anterior displacement of radial shaft. Ulna fracture was fixed by elastic nailing and radial neck fracture was managed by closed means (with or without fixation). At final follow up (2 and 7 years later respectively), both the children had excellent outcomes with good range of pronation and supination movements.
Conclusion: In the management of Monteggia equivalent lesions, an understanding of the direction of displacement of radial shaft will help in formulating the appropriate method of fracture reduction. Closed reduction of the radial neck fracture is preferred since the results of open reduction are poor especially in terms of regaining pronation and supination movements.
Keywords: Monteggia, Forearm fracture, Monteggia variant
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| How to Cite this Article: Narasimhan R, Gautam V | Management of Paediatric Monteggia Variant Fracture – Our Experience of Two Similar Cases| International Journal of Paediatric Orthopaedics | May-August 2023; 9(2): 30-33 | https://doi.org/10.13107/ijpo.2023.v09.i02.169
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