Monteggia variant: An unusual presentation

Abstract

Introduction Double injury patterns in the form of Monteggia or Galeazzi fracture dislocation represent a spectrum of forearm injuries which are severe and usually necessitate operative intervention. Association of ulnar dislocation with proximal radioulnar disruption with fracture of the radial shaft, without dislocation of radiohumeral joint, represents a rare and unusual double injury pattern which is not classified under the Bado classification system. Although easy to identify, understanding the injury morphology ensures proper treatment. The aim of this study is to present an unusual case of Monteggia variant. Case Report A 26-year-old male presented following a road traffic accident with posterior dislocation of ulna and proximal radioulnar disruption with radial shaft fracture at the junction of proximal and middle third; radial head maintained its relation with capitellum. Valgus instability necessitating treatment could be demonstrated despite of posterolateral stability even after close reduction and fixation of radius. Conclusion This injury may be classified as an unusual variant of Monteggia fracture dislocation with emphasis on associated management of medial collateral ligament depending on the patient's profile and fracture personality for optimal results.

Ulnohumeral dislocation despite intact radiocapitellar joint: a rare Monteggia variant

“…A few cases have been reported having radial shaft fractures combined with ulnohumeral dislocation but intact radiocapitellar joint. 8,9 The most striking observation in this case is that, despite the large displacement of ulna during the intra-operative stress test, the radial head still maintained its congruency in the radiocapitellar joint. It is normally understood that the radius is connected to the ulna through the ligaments of the PRUJ and DRUJ and also the interosseous membrane, whereas no ligamentous connection exists between the radius and the humerus.…”

“…Despite the extensive injury, the radiocapitellar joint was perfectly reduced even when ulna was dislocated. We know of two earlier reported cases similar to this, 8,9 although the mechanism behind the radiocapitellar congruency was not discussed in either of these reports.…”

“…A few cases have been reported having radial shaft fractures combined with ulnohumeral dislocation but intact radiocapitellar joint. 8,9…”

Type III monteggia equivalent injury with compartment syndrome in an 8 year old child: A case report

“…5 Simultaneously proximal and distal forearm fractures are very rare. Previous such combinations reported include: Type-I Monteggia with ipsilateral fracture of distal radius epiphyseal injury 3 ; type II Monteggia fracture with fracture separation of the distal radial physis 6 ; type III Monteggia injury with ipsilateral distal radius and ulna fractures 2 ;olecranon fracture and distal radial epiphysis 7 ; type IV Monteggia injury with distal diaphyseal fracture of the radius 8 ;eleven cases of *Monteggia fracture dislocation with fracture of the ipsilateral radius and ulna 5 ;one case of three epiphyseal fractures (distal radius and ulna and proximal radius) and a diaphyseal ulnar fracture in the same forearm 9 ; one case of humeroulnar dislocation with proximal radioulnar disruption with fracture of the radial shaft, without dislocation of radiocapitellar joint 10 ; Type III monteggia injury with ipsilateral type II Salter Harris injury of the distal radius and ulna in a child 11 ; one case of combined type III Monteggia injury with ipsilateral Type II Salter-Harris injury of distal end radius with a metaphyseal fracture of the distal third of the ulna and one case of a closed fracture of atypical Type I Monteggia hybrid lesion with proximal ulna fracture extending into the olecranon involving the articular surface. 12 There has been only one case report of compartment syndrome with Monteggia fracture dislocation.…”