The prognosis is significantly decreased by delayed diagnosis and treatment. Long oblique/ comminuted fracture: open reduction and internal fixation In the paediatric population, treatment depends on the type of ulnar fracture: 7,8īowing/ greenstick fracture: closed reduction of the ulnar bow and casting if reduction of the radial head is not possible, open osteotomy and fixation of the ulna may be requiredĬomplete transverse/short oblique fracture: closed reduction and intramedullary fixation Usually, anatomical reduction of the ulna allows for a closed reduction of the radial head. Types I, III, IV are cast at 110° of flexion, whereas type II is cast at 70° of flexion 4,6. In the paediatric population, isolated closed reduction may be possible. Following the trauma, he sustained an ipsila-teral fracture of the distal intercondylar hume-rus (AO classification 13-B1) and a Monteggia fracture-dislocation (Bado I type) of the left forearm (Figure 1). That an apparently isolated ulnar plastic/ greenstick fracture may actually represent a Monteggia-equivalent lesion with spontaneous radial head reductionĪll four types of Monteggia fracture-dislocations (see Bado classification) are typically treated with open reduction and internal fixation of the ulna and radius. health, non-smoker, and had already suffered a left radial shaft and a right distal radius fracture. That up to 24% of cases are associated with a distal radial fracture The age-dependent normal appearance of the elbow centres of ossification, which could mimic a fracture to the inexperienced eye The management of these injuries can be difficult. Regarding paediatric patients, one should take into account: Background High-energy trauma may result in uncommon open injuries around the elbow joint. Provided that films of adequate quality are obtained, the ulnar fracture is usually obvious and the radial head dislocation should be readily identifiable. ![]() When a forearm fracture is identified, dedicated imaging of both the elbow and the wrist is important and good quality AP and lateral views are essential. ![]() ![]() They present in very much the same way as other pediatric upper. Monteggia fractures occur mostly in children (peak incidence at ages 4-10 years) and rarely in adults. The pediatric Monteggia fracture typically affects children between the ages of 4 and 10 years of age.
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