Monteggia Lesion in a Child: Variant of a Bado Type-Iv Lesion. A Case Report

Value of Computed Tomography Scan to Evaluate the Radio Capitellar joint in Monteggia type IV lesion

“…In types I-III of Bado`s classification, the fractures of the ulna are associated with the dislocation of the proximal radio ulnar joint; in contrast, Type IV is characterized by fracture of both forearm bones with anterior dislocation of the radial head. Bhandari & Jindal [3] reported a type IV case with posterolateral dislocation of the radial head, so they suggested subgroups of Monteggia type IV injury according the direction of the radial head dislocation: Type IV-A lesion the fractures of the radius and ulna are associated with anterior dislocation of the radial head, type IV-B with posterior dislocation, type IV-C with lateral dislocation and type IV-D there is a combination of types IV-A with IV-C or IV-B with IV-C.…”

A youngest reported case of type II Monteggia lesion associated with a posterior ulnohumeral dislocation

“…It is usually very difficult to determine the exact mechanism of injury in young adults, who are usually unable to provide precise details of the sequence of events [11]. However, the position of the forearm when the patient is first seen, the position of the distal radius on roentgenograms, the direction of dislocation of radial head, and the direction of angulation of ulnar fracture, all provide indirect clues about the mechanism of injury [12]. One of the most widely accepted theories is that isolated Monteggia fracture– dislocation is caused by hyperpronation as described by Evans [13].…”

Monteggia Type IV Equivalent Injury

“…Bhandari and Jindal [ 11 ] reported a type IV case with posterolateral dislocation of the radial head, so they suggested subgroups of Monteggia type IV injury. In Type IV-A lesion the fractures of the radius and ulna are associated with anterior dislocation of the radial head, in type IV-B with posterior dislocation, in type IV-C with lateral dislocation and in type IV-D there is a combination of types IV-A with IV-C or IV-B with IV-C.…”

“…Monteggia type IV lesions have been treated by both closed [ 4 , 5 , 13 ] and open techniques [ 1 , 5 , 9 - 11 ]. The degree of angulation or shortening of the forearm bones and late presentation of the patient were evaluated to estimate whether closed or open treatment modalities may be needed and to predict the final outcome [ 5 ].…”