Lateral Humeral Condylar Fracture in a Paediatric Monteggia Type Iii Equivalent

Abstract

Monteggia fracture dislocations can be classic or equivalents. Equivalents, also known as Monteggia like lesions, are very rare especially type III and IV, which have been added to the literature after Luis Bado presented the original classification system of Monteggia fracture dislocations. Type III equivalent is classically defined as a proximal ulna fracture associated with a fracture of the lateral condyle of the humerus. In the literature only seven such cases have been reported so far. Here we present two such cases where one eight-year-old boy had a complex type of injury with a shear type fracture of the lateral humeral condyle and other a seven-year-old boy who had a plastic deformity of the ulna with an avulsion type fracture of the lateral humeral condyle. We also try to describe a novel mechanism of injury, known as, “Barzulla circle”, for the classical as well as equivalent type III Monteggia fracture dislocations.

Concurrent ulnar plastic deformity and ipsilateral humeral condylar fracture: A case report

“…Our literature review yielded only a similar case reported by Nadeem et al [20] , who described a 7-year-old boy with the concurrence of an LHCF and an ulnar plastic deformity. In contrast, Nadeem and colleagues applied the closed reduction approach to treat the LHCF before correcting the plastic deformity of the ulna with a suitable maneuver.…”

“…In contrast, Nadeem and colleagues applied the closed reduction approach to treat the LHCF before correcting the plastic deformity of the ulna with a suitable maneuver. However, checking the fracture under pressure in the operating room, they found the broken part unstable and displaced, prompting them to perform the open reduction technique to set the fracture [20] . We, therefore, conclude that the closed reduction maneuver to fix an LHCF accompanied by an ulnar deformity could be compromised by inappropriate pressures exerted intraoperatively on the ulna, resulting in the instability and displacement of the joint surfaces.…”