Management of Neglected Pediatric Monteggia Fracture-Dislocation: A Case Report and Literature Review

Sudhir Shankar  Mane; P. Jayaram  Reddy; Kyatham L.  Jagadishwer Rao

doi:10.18502/jost.v10i3.16785

Sudhir Shankar Mane Resident, Department of Orthopedics, SVS Medical College, Mahabubnagar, Telangana, India
P. Jayaram Reddy Associate Professor, Department of Orthopedics, SVS Medical College, Mahabubnagar, Telangana, India
Kyatham L. Jagadishwer Rao Professor, Department of Orthopedics, SVS Medical College, Mahabubnagar, Telangana, India

DOI: https://doi.org/10.18502/jost.v10i3.16785

Keywords: Elbow Fractures; Forearm Injuries; Monteggia Fracture Dislocations; Osteotomy

Abstract

Background: Missed or neglected Monteggia lesions are defined as classical fracture-dislocation presenting at least four weeks after injury. This injury in children is often challenging to treat and requires complex methods to achieve optimal results.

Case Report: We report a 6-year-old girl with a 2-month-old neglected Bado type-I Monteggia fracture-dislocation. Our patient underwent ulnar osteotomy, bone grafting, and fixation with a semi-tubular plate along with open radial head reduction. Although the patient experienced wound complications at the bone graft harvest site, she achieved an excellent outcome with restored functionality and range of motion (ROM).

Conclusion: Neglected Monteggia injuries in pediatric patients demand multifaceted treatment approaches due to their complexity and potential for long-term functional impairment. The absence of a consensus on definitive treatment underscores the importance of early diagnosis and open reduction to enhance long-term outcomes. This case report highlights the effectiveness of ulnar osteotomy, plate fixation, and open radial head reduction in achieving favorable results.