Saleh Ehab S
Department of Orthopedic Surgery, William Beaumont Hospital, Royal Oak, Michigan.
Oakland University William Beaumont School of Medicine, Rochester, Michigan.
J Orthop Case Rep. 2021 Oct;11(10):17-20. doi: 10.13107/jocr.2021.v11.i10.2448.
Monteggia fracture-dislocations are rare and complex injuries that usually involve a fracture of the proximal ulna associated with a proximal radioulnar and radiocapitellar joint dislocations. These injuries comprise <1% of all pediatric forearm fractures. We report on a pediatric Monteggia fracture-dislocation variant that included an irreducible divergent ulnohumeral joint dislocation, an irreducible anterior radial head dislocation, and a proximal and distal radius and ulna fracture.
A 6-year-old female came to our emergency room with a right elbow and forearm pain and deformity after a fall from a slide on the same day. X-rays revealed a divergent ulnohumeral joint dislocation, an anterior radiocapitellar joint dislocation, a proximal radioulnar joint dislocation, and a proximal and distal ulna and radius fracture. Closed reduction under sedation in the emergency room was not successful, with persistent ulnohumeral, ulnoradial, and radiocapitellar joint dislocations. The patient was taken to the operating room the next morning. She underwent open reduction and internal fixation of the proximal ulna fracture with a one-third tubular locking plate, and radial head dislocation open reduction. A stable reduction of the ulnohumeral joint was only possible after the fixation of the proximal ulna fracture. The most stable position for the radiocapitellar joint after its open reduction was at 70o of elbow extension and full forearm supination; the patient was casted in that position for 6 weeks.
Pediatric Monteggia fracture-dislocations are rare and complex childhood fractures, and new variants of this injury can have even more complex presentations. Open reduction and stable internal fixation addressing all components of this injury will lead to an excellent outcome.
孟氏骨折脱位是罕见且复杂的损伤，通常包括尺骨近端骨折并伴有近端桡尺关节和桡骨头关节脱位。这些损伤占所有小儿前臂骨折的比例不到1%。我们报告了一种小儿孟氏骨折脱位变体，其中包括不可复位的分离性尺肱关节脱位、不可复位的桡骨头前脱位以及桡尺骨近端和远端骨折。
一名6岁女性当天从滑梯上摔倒后，因右肘和前臂疼痛及畸形来到我们的急诊室。X线显示分离性尺肱关节脱位、桡骨头前关节脱位、近端桡尺关节脱位以及尺桡骨近端和远端骨折。在急诊室镇静下进行闭合复位未成功，尺肱、尺桡和桡骨头关节脱位持续存在。患者于次日上午被送往手术室。她接受了用三分之一管形锁定钢板对尺骨近端骨折进行切开复位内固定以及桡骨头脱位切开复位。只有在尺骨近端骨折固定后，尺肱关节才能实现稳定复位。桡骨头关节切开复位后最稳定的位置是在肘关节伸展70°且前臂完全旋后时；患者在此位置用石膏固定6周。
小儿孟氏骨折脱位是罕见且复杂的儿童骨折，这种损伤的新变体会有更复杂的表现。对该损伤的所有组成部分进行切开复位和稳定的内固定将带来良好的结果。
