Published online Nov 18, 2021. doi: 10.5312/wjo.v12.i11.954
Peer-review started: July 5, 2021
First decision: July 28, 2021
Revised: August 30, 2021
Accepted: September 27, 2021
Article in press: September 27, 2021
Published online: November 18, 2021
Monteggia fractures are uncommon injuries in paediatric age. Treatment algorithms assert that length-unstable fractures are treated with plate fixation. In this case report, intramedullary fixation of an acute length-unstable Monteggia fracture allowed a stable reduction to be achieved, along with an appropriate ulnar length and alignment as well as radio capitellar reduction despite the fact that the orthopaedic surgeon did not use a plate for the ulnar fracture. The scope of treatment is to avoid the use of a plate that causes periosteal stripping and blood circulation disruption around the fracture.
A four-year-old girl presented at the Emergency Department following an accidental fall off a chair onto the right forearm. The X-ray highlighted a length-unstable acute Bado type 1 Monteggia fracture of the right forearm. On the same day, the patient underwent surgical treatment of the Monteggia fracture. The surgeon preferred not to use a plate to avoid a delay in fracture healing and to allow the micromotion necessary for callus formation. The operation comprised percutaneous fixation with an elastic intramedullary K-wire of the ulnar fracture and, subsequently, humeroradial joint reduction through manual manipulation. The orthopaedic surgeon assessed the stability of the radial head reduction under fluoroscopic control through flexion, extension, pronation and supination of the forearm. Healing of the fracture occurred within six weeks after surgery, as indicated by the presence of calluses on at least three cortices on standard radiographs. Dislocation/subluxation or loss of ulnar reduction was not apparent at the final X-ray examination.
Intramedullary fixation of unstable Monteggia fractures results in excellent outcomes, provides reliable reduction and causes fewer complications.
Core Tip: Treatment algorithms assert that acute length-stable Monteggia fractures are treated with an intramedullary device, while acute length-unstable fractures are treated with plates. Intramedullary devices have the advantage of smaller skin incisions, less soft tissue disruption, shorter operative times and easier device removal. Plates allow more anatomical restoration of the ulnar fracture and the radial bow, although they can cause delayed union due to blood circulation disruption around the fracture. Intramedullary wires can be used for the treatment of acute length-unstable Monteggia fractures instead of plates as these are associated with excellent results and fewer complications.