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Igaki R, Yasuda T, Samejima Y, Murakami Y, Takagi S, Kawasaki K. Ipsilateral supracondylar humerus fracture and Monteggia fracture-dislocation with distal radius physeal fracture in a pediatric patient: A case report. Trauma Case Rep 2025; 56:101151. [PMID: 40129702 PMCID: PMC11930573 DOI: 10.1016/j.tcr.2025.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2025] [Indexed: 03/26/2025] Open
Abstract
In pediatric patients, supracondylar humerus fractures concurrent with Monteggia fracture-dislocation and Monteggia fracture-dislocation concurrent with distal radius fracture are rare and have only been reported in case reports. We present the case of a 10-year-old girl with concurrent ipsilateral arm supracondylar humerus fracture with Monteggia fracture-dislocation and distal radius physeal fracture, which were treated with closed reduction and percutaneous pinning. The Monteggia fracture-dislocation was addressed with open reduction via a posterior approach and fixation using titanium elastic nails. The postoperative recovery was favorable. At 1-year postoperative follow-up, the Mayo Elbow Performance score was 100 points, and no limitations in joint range of motion were noted.
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Affiliation(s)
- Ryu Igaki
- Department of Plastic and Reconstructive Surg, Showa University School of Medicine, Tokyo, Japan
| | - Tomohiro Yasuda
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yuki Samejima
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yuto Murakami
- Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Shinsuke Takagi
- Department of Plastic and Reconstructive Surg, Showa University School of Medicine, Tokyo, Japan
| | - Keikichi Kawasaki
- Department of Orthopaedic Surgery, Showa University Northern Yokohama Hospital, Yokohama, Japan
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Yakushiji R, Ogawa T, Ikumi A, Kobayashi K, Yoshii Y. Combined Pediatric T-condylar Humeral Fracture and Monteggia Fracture-Dislocation in the Upper Extremity: A Case Report. Cureus 2025; 17:e81866. [PMID: 40342438 PMCID: PMC12059601 DOI: 10.7759/cureus.81866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2025] [Indexed: 05/11/2025] Open
Abstract
Monteggia fractures are characterized by a fracture of the ulna associated with radial head dislocation. T-condylar fractures of the humerus are intra-articular injuries that disrupt the distal humeral epiphysis. This report describes a rare case of a pediatric patient with an ipsilateral T-condylar humeral fracture and a Monteggia fracture-dislocation. A 10-year-old girl presented with elbow pain and deformity after falling while playing basketball. No open wounds or neurological deficits were observed, and the radial artery was palpable. The radiograph revealed a pediatric T-condylar humeral fracture and a Bado classification type I Monteggia fracture-dislocation. Surgery was performed on the day of injury, and the ulnar shaft fracture was repaired with a titanium elastic nail. Subsequently, the humeral condyle was stabilized with Kirschner wire fixation. Bone union was confirmed at two months postoperatively, and the nails and wires were removed at six months postoperatively. Two years post-surgery, the patient had full elbow range of motion with no growth disturbances, deformities, or pain. This rare upper extremity fracture-dislocation case illustrates the need for prompt surgery and long-term follow-up to monitor growth and function.
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Affiliation(s)
- Ryo Yakushiji
- Department of Orthopedic Surgery, National Hospital Organization, Mito Medical Center, Ibaraki, JPN
| | - Takeshi Ogawa
- Department of Orthopedic Surgery, National Hospital Organization, Mito Medical Center, Ibaraki, JPN
| | - Akira Ikumi
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, JPN
| | - Kenji Kobayashi
- Department of Orthopedic Surgery, National Hospital Organization, Mito Medical Center, Ibaraki, JPN
| | - Yuichi Yoshii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ibaraki, JPN
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Su F, Li M, Ma Y, Yang Y, Hao X, Jia H, Dang Y, Lu Q, Liu C, Yang S, Wang H, Wang B, Jie Q. The diagnosis and treatment of a special rare type of Monteggia equivalent fractures in children. Front Pediatr 2023; 11:1120256. [PMID: 37056941 PMCID: PMC10086178 DOI: 10.3389/fped.2023.1120256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/10/2023] [Indexed: 04/15/2023] Open
Abstract
Purpose To explore the characteristics, mechanism, treatment, and prognosis of head-neck separation type of Monteggia equivalent fractures in children. Methods Patients with this injury were reviewed retrospectively. The lesion was characterized by a fracture of the ulnar with radial neck fracture but without dislocation of the radial head. Our classification was based on the direction of displacement and angulation of fractures on radiographs, divided into the extension-valgus type and flexion-varus type. The fractures were treated with reduction and internal fixation, depending on the fracture type. The clinical results were evaluated by using radiology and the Mayo Elbow Performance Score (MEPS). Results A total of 12 patients were followed up for an average of 40.5 months. The ulnar fractures were treated with closed reduction (CR) and K-wire fixation in one patient, elastic stable intramedullary nail (ESIN) fixation in four patients, open reduction (OR) and plate fixation in five, with no fixation in two. CR with ESIN fixation was successful in 11 patients with radial neck fractures, but one underwent OR and K-wire fixation. All fractures healed on time, with fewer complications (avascular necrosis in one patient, and bulk formation of metaphysis in another). The therapeutic efficacy was evaluated by using MEPS and was found to be excellent in 10 patients, good in one, and fair in another. Conclusions The head-neck separation type of Monteggia equivalent fractures in children is rare. Its characteristics are different from that of Monteggia fracture. The length and anatomic structure of the ulna should be restored and stabilized first, while the radial neck fracture should be treated with CR and ESIN fixation. Satisfactory clinical results can be achieved with fewer complications.
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Affiliation(s)
- Fei Su
- Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China
- Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China
| | - Min Li
- Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China
- Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China
| | - Yishan Ma
- Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China
- Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China
| | - Yating Yang
- Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China
- Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China
| | - Xue Hao
- Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China
- Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China
| | - Haoruo Jia
- Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China
- Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China
| | - Youting Dang
- Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China
- Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China
| | - Qingda Lu
- Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China
- Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China
| | - Chenxin Liu
- Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China
- Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China
| | - Shuai Yang
- Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China
- Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China
| | - Huan Wang
- Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China
- Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China
| | - Bing Wang
- Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China
- Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China
- Correspondence: Bing Wang Qiang Jie
| | - Qiang Jie
- Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China
- Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China
- Correspondence: Bing Wang Qiang Jie
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Li ML, Zhou WZ, Li LY, Li QW. Monteggia type-I equivalent fracture in a fourteen-month-old child: A case report. World J Clin Cases 2021; 9:9228-9235. [PMID: 34786409 PMCID: PMC8567499 DOI: 10.12998/wjcc.v9.i30.9228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/17/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Monteggia and equivalent lesions are relatively rare but result in severe injuries in childhood, typically affecting children between 4 and 10 years old. The diagnosis and treatment of an equivalent Monteggia lesion is more complicated than those of a typical Monteggia fracture. This type of lesion may be challenging and may lead to serious complications if not treated properly. Pediatric Monteggia equivalent type I lesions have been reported in a few reports, all of which the patients were all over 4 years old.
CASE SUMMARY A 14-mo-old boy was referred to our clinic after falling from his bed 10 d prior. With regard to the clinical examination, an obvious swollen and angular deformity was noted on his right forearm. Plain radiographs and reconstructed computed tomography scans showed a Monteggia type I fracture and dislocation. Magnetic resonance imaging (MRI) confirmed a type I Monteggia equivalent lesion consisting of ulnar fracture and Salter-Harris type I injury in the proximal radius. The radial head was still in the joint, and only the radial metaphysis was displaced anteriorly. Open reduction and pinning of both displaced radial and ulnar fractures achieved an excellent result with full function.
CONCLUSION We recommend MRI examination or arthrography during reduction, especially if the secondary ossification center has not appeared.
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Affiliation(s)
- Ming-Lei Li
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Wei-Zheng Zhou
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Lian-Yong Li
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Qi-Wei Li
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Abstract
PURPOSE The aim of the study is to evaluate our group of paediatric patients with Monteggia lesion and its equivalents and to compare the characteristics of basic types of these lesions concerning therapeutic approach and results of the treatment. METHODS Retrospective study of 111 children treated in the Department of Pediatric and Trauma Surgery of the Thomayer Hospital in Prague between 2001 and 2013 (13 years). When evaluating the outcome of the therapy, Bruce's criteria modified by Letts that assesses range of movement, pain and deformity of the elbow joint were applied. Regarding the therapeutic approach, four groups were compared: nonoperative treatment, reduction and casting, closed reduction and internal fixation (CRIF) and opened reduction and internal fixation (ORIF). Results were compared between three groups of patients (Monteggia lesions, displaced equivalents and non-displaced equivalents) using Fisher´s exact test with α set to 0.05. RESULTS In all, 46 patients were treated for (true) Monteggia lesion, 27 for non-displaced Monteggia equivalent and 38 for displaced equivalent. There is a statistically significant difference in therapeutic approach between all three groups of patients. There is no significant difference in outcome between Monteggia lesions and both types of Monteggia equivalents, but there is a statistically significant difference between displaced and non-displaced equivalents. CONCLUSION There are only two lesions that meet the criteria of Monteggia - (true) Monteggia lesion and displaced Monteggia equivalent. The non-displaced equivalent does not meet the criteria of Monteggia and, therefore, should not be termed a Monteggia equivalent. LEVEL OF EVIDENCE Level III - Retrospective comparative study.
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Affiliation(s)
- M. Čepelík
- Department of Pediatric and Trauma Surgery, Third Faculty of Medicine, Charles University and Thomayer Hospital, Prague,Correspondence should be sent to M. Čepelík, Prokopova 10, 130 00 Prague, Czech Republic. E-mail:
| | - T. Pešl
- Department of Pediatric and Trauma Surgery, Third Faculty of Medicine, Charles University and Thomayer Hospital, Prague
| | - J. Hendrych
- Department of Pediatric and Trauma Surgery, Third Faculty of Medicine, Charles University and Thomayer Hospital, Prague
| | - P. Havránek
- Department of Pediatric and Trauma Surgery, Third Faculty of Medicine, Charles University and Thomayer Hospital, Prague
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Gokkus K, Kose O, Saylik M, Sagtas E, Turan Aydin A. Pediatric Olecranon Fractures Associated With Radial Neck Fractures: Review and Report of Two Cases. Trauma Mon 2016; 21:e20686. [PMID: 27921015 PMCID: PMC5124109 DOI: 10.5812/traumamon.20686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/19/2014] [Accepted: 09/23/2014] [Indexed: 12/29/2022] Open
Abstract
Introduction The debate regarding the description on classification and nomenclature of the injury which includes olecranon fracture associated with radial neck fractures in children is ongoing. We report two pediatric cases that could not be classified in a Monteggia-equivalents system and were treated with open reduction and k-wire fixation. The aim of this study was to perform a systematic review regarding pediatric radial neck fractures associated with olecranon fractures and presentation of two pediatric cases of olecranon fractures associated with radial neck fractures with radiocapitellar dislocation. Case Presentation Two boys, aged 7 and 12, came to two separate clinics on the same day after initial injury. On physical examination, the patients’ elbow range of motion was limited and painful. Their upper extremities were intact. Radiographs revealed the radial neck fracture with prominent anterolateral radiocapitellar dislocation of radial head-associated with non-displaced olecranon fracture. Radial neck fracture was reduced easily by pushing posteromedially manually with the finger and secured with two K-wires .The olecranon fracture was visualized and confirmed that it was non-displaced and secured with two k-wires in the first case and one k-wire in the second case. After 2 months of follow-up, both patients had no pain in their elbow and a full functionality with a full range of motion of the elbow. The posterior intraosseous nerve functions were normal. Conclusions The fracture of olecranon if it does not extend into the metaphyseal region; it could not fascilitate diastasis of the proximal radioulnar joint and radial head dislocation. So this type of fracture must not be addressed as a Monteggia-fracture dislocation. The description of radioulnar diastasis must be included when this type of injury is to be classified.
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Affiliation(s)
- Kemal Gokkus
- Orthopaedics and Trauma Department, Ozel Antalya Memorial Hospital, Antalya, Turkey
- Corresponding author: Kemal Gokkus, Private Memorial Antalya Hospital, Yildirim Beyazit Cad. Number 91, Kepez, Antalya, Turkey. Tel: +90-2423146666, Fax: +90-2423441678, E-mail:
| | - Ozkan Kose
- Orthopaedics and Trauma Department, Antalya Training and Research Hospital, Antalya, Turkey
| | - Murat Saylik
- Orthopaedics and Trauma Department, Bursa Ozel Bahar Hospital, Bursa, Turkey
| | - Ergin Sagtas
- Radiodiagnostic Department, Antalya Memorial Hospital, Antalya, Turkey
| | - Ahmet Turan Aydin
- Orthopaedics and Trauma Department, Ozel Antalya Memorial Hospital, Antalya, Turkey
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Cobanoglu M, Şavk ŞO, Cullu E, Duygun F. Ipsilateral supracondylar humerus fracture and Monteggia lesion with a 5-year follow-up: a rare injury in a young girl. BMJ Case Rep 2015; 2015:bcr-2014-206313. [PMID: 25926578 DOI: 10.1136/bcr-2014-206313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although elbow injuries and fractures of the forearm are common in children, the combination of these injuries is rare. We present a case of a 5-year-old patient with a concomitant ipsilateral supracondylar humerus fracture and Monteggia lesion. After physical and radiographic examination of the injured extremity in the emergency department, closed reduction and percutaneous pinning were performed under image intensifier under general anaesthesia. A long-arm cast was applied for postoperative immobilisation. Excellent radiological and functional outcomes were obtained at the end of 1-year follow-up and no deformity was observed at 5-year follow-up.
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Affiliation(s)
- Mutlu Cobanoglu
- Department of Orthopaedics and Traumatology, Adnan Menderes University, Aydın, Turkey
| | - Şevki Oner Şavk
- Department of Orthopaedics and Traumatology, Adnan Menderes University, Aydın, Turkey
| | - Emre Cullu
- Department of Orthopaedics and Traumatology, Adnan Menderes University, Aydın, Turkey
| | - Fatih Duygun
- Department of Orthopaedics and Traumatology, Antalya Education and Research Hospital, Antalya, Turkey
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