A 22-Month old with a Neglected Monteggia Injury: A Case Report and Review of the Literature

INTRODUCTION: A pediatric Monteggia injury, when the diagnosis is missed or neglected, is still a challenging problem for the treating orthopedic surgeon. In this case report, we report our treatment method for a neglected Monteggia injury in a 22-month-old child. CASE PRESENTATION: A 22-month-old female patient had a history of significant trauma 8 months earlier, but no referral was made to any health institution during this period. The patient presented with swelling in the right elbow and what the family described as an occasional click noise during elbow movements. There was a 1/3 proximal plastic deformation of the ulna on radiographs, with anterior bowing concomitant with an anterior dislocation of the radial head. The patient was evaluated with a diagnosis of neglected type I Monteggia lesion. Conservative follow-up was carried out by applying closed reduction of the radiocapitellar joint under sedation. However, the conservative treatment method failed after 1 week of follow-up. For definitive treatment, closed radiocapitellar reduction and ulnar osteotomy (intramedullary Kirschner wire and oblique Kirschner wires) were applied. At the end of 3 months, the patient had full open range of motion in all directions without pain. CONCLUSION: This case report is noteworthy due to the patient’s young age and the ulnar fixation method applied. It also shows that in the presence of ulnar bowing, maintenance of radiocapitellar reduction with only closed reduction without ulnar osteotomy could not be achieved.