Main Article Content

Dr Nur Syuhadah Zainol Abidin

Abstract

Introduction: 


Chronic Monteggia fracture is an unreduced dislocation of the radio-capitellar joint that is still present 4 weeks after the injury. The most common cause is a missed diagnosis from initial presentation. Posterior interroseous nerve injury (PIN) is a common complication following a chronic  Monteggia fracture. 


 


Case report: 


A 7- year-old boy presented to emergency department (ED) due to a painful and deformed right forearm following a fall when his bicycle skidded.  On examination, there was swelling, deformity and tenderness of the right forearm. The range of movement of the right elbow was limited due to pain, however no neurovascular deficit observed. X-ray showed a non-displaced fracture of the proximal third of the right ulna. He was discharged with above elbow back slab and analgesia. During his visit to orthoapedic clinic two months later, he complained of persistent pain over the right elbow, and examination revealed a finger drop with limited supination. A repeated X-ray showed right radial head dislocation which was missed previously during the initial presentation to ED. A diagnosis of chronic Monteggia fracture with posterior interosseous nerve (PIN) injury was made. He underwent open reduction and internal fixation (ORIF) of the right radial head with ulnar ostetomy  and radio-capitellar K wire insertion. Post operative recovery was uneventful. 


 


Discussion: 


Monteggia fracture represents 0.4% of paediatric fractures, but the incidence of chronic injuries is unknown. Despite its rarity, it is being missed in up to 50% of cases. The most common cause of chronic Monteggia fracture is a missed diagnosis from initial presentation. In this case, the fracture had been missed for two months since the trauma. Therefore, the radial head dislocation is being left untreated, leading to pain, limited supination and PIN injury.  Special consideration should be given to the fine motor development since PIN injury results in a finger drop, which restricted the activities of daily livings and writing. Surgical reconstruction is warranted to improve the function and hand and to prevent further complications. 


 


Conclusion 


A chronic Monteggia fracture is an extremely a rare injury in a paediatric population. It leads to several complications such as pain,  reduced elbow’s range of motion and PIN injury. Surgical intervention is the mainstay of the management with good outcome and improvement in function. 

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Article Details

Section
EMAS Meeting 2021 Abstracts