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CASE REPORT
Ipsilateral Distal Radius, Ulna And Proximal Ulna Fracture: A Case Report

* Botchu R, Korwar V, Sunil S, Slater R N S

*Department of Trauma and Orthopaedics, Maidstone Hospital, Maidstone, UK

Address for Correspondence

Mr Rajesh Botchu,
Department of Trauma and Orthopaedics, Maidstone Hospital, Hermitage lane,
Maidstone, Kent, ME16 9QQ, UK.
Phone: 0044 1622 224335
Fax: 0044 1622 224335
E Mail: drbrajesh@yahoo.com

Abstract

We report the case of a seven-year-old boy who fell off a monkey bar and sustained fracture of distal radius, proximal and distal ulna on the left side. A satisfactory reduction of the displacement was achieved by closed manipulation under anaesthesia. We believe that this fracture should be considered as one of the monteggia variant.
Keywords
:Monetggia, fracture, equivalent

J.Orthopaedics 2006;3(2)e11

Introduction :

Monteggia fractures and equivalents are one of the commonest fractures in children. We report a seven year old boy who sustained Salter Harris type 2 fractures of distal radius and ulna and green stick fracture of proximal ulna.

Case Report:

Seven-year-old right hand dominant boy presented with pain, swelling and deformity of left forearm and elbow following a fall off the monkey bar (Eight feet height). Examination revealed tenderness at left wrist and elbow without neuro- vascular deficits. Radiographs showed a Salter Harris type 2 fracture of distal radius with posterolateral displacement. He also had a Salter Harris type 2 fracture of the distal ulna which had displaced postero laterally. (Figure 1) The fracture involving proximal third of ulna was a green stick fracture with dorsal angulation. (Figure 2) There was no dislocation of the proximal and distal radio-ulnar joints. He was managed with closed reduction and immobilisation in an above elbow plaster cast. (Figure 3)

Discussion :

Monteggaia fractures and Monteggia equivalents are one of the common fractures in children. Bado had classified monteggia fractures in to 4 types depending on the direction of dislocation of radial head1.

Bado's Classification

  • Type I - Anterior dislocation of the radial head and fracture of the ulnar diaphysis at any level with anterior angulation. Most common fracture pattern.

  • Type II - Posterior dislocation of the radial head and fracture of the ulnar diaphysis with posterior angulation. Rare in children.

  • Type III - Lateral dislocation of the radial head with fracture of the ulnar metaphysis. More common in children than adults.

  • Type IV - Anterior dislocation of the radial head with fracture of the proximal third of the radius and fracture of the ulna at the same level.

Letts classified such fractures in children into five groups2. A (plastic deformation of the ulna), B (green stick fracture) and C (complete fracture) are essentially variations of a Bado I lesion. D and E correspond to type II and type III respectively. He considered Bado IV to be a type I variant.

The various monetggia equivalents are:

  • Anterior dislocation of the radial head with plastic deformation of the ulna.

  • Fracture of the ulnar diaphysis with a fracture of the neck of the radius.

  • Fracture of the ulnar diaphysis with a fracture of the proximal third of the radius proximal to the ulnar fracture.

  • Fracture of the ulnar metaphysis with anterior dislocation of the radius.

  • Fracture of the ulnar diaphysis with anterior dislocation of the radial head and fracture of the olecranon.

  • Fracture of the ulnar metaphysis with fracture of the neck of the radius.

  • Posterior dislocation of the elbow and fracture of the ulnar diaphysis, with or without fracture of the proximal radius.

In our case the mechanism of injury is fall on his left side with a dorsiflexed wrist, pronated forearm with slight flexion at the elbow. This combination of forces might have resulted in this rare fracture. Osada D et al reported a similar kind of rare fracture of ipsilateral distal radius and ulna, proximal radius and diaphysis of ulna in an eight year old girl which was treated by open reduction and internal fixation3. 

Such fractures should be considered as a monteggia variant and can be managed conservatively with closed reduction and immobilisation in an above elbow plaster cast.

Conclusion :

We feel that such combination of fractures in children should be considered as a monteggia variant.

Reference :

  1. Cole WH. Primary Tumours of Patella. J Bone Joint Surg 1925; 23: 637-654.

  2. Deepak Chaudhary, Naval Bhatia, Abrar Ahmed, Chopra R K. Unicameral bone cyst of the Patella. Orthopaedics 2000; 12: 1285-1286.

  3. Ferguson PC, Griffin AM, Bell RS. Primary Patellar Tumours. Clin Orthop 1997; 336: 199-204.

  4. Jucker C, Cuneo L. Juvenile solitary bone cysts of the patella. Presentation of a case report. Ann Radiol Diagn (Bologna). 1962; 35: 192-194.

  5. Linda M Parman, Mark D Murphey. Alphabet Soup: Cystic Lesions of Bone. Seminars in Musculoskeletal Radiology 2000; 4(1): 89-101

  6. Masaki Chigira, Susumu Maehara, Satoru Arita, Ehchi Udagawa. The aetiology and treatment of simple bone cysts. J Bone Joint Surg [Br] 1983; 65B:  633-636.

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  9. Schultz E, Greenspan A. Case report 378: Simple bone cyst. Skeletal Radiol 1986; 15(5): 405-407.

  10. Weintroub S, Salama R, Baratz M, Papo I, Weissman SL. Unicameral bone cyst of the Patella. Clin Orthop 1979; 140: 158-161.

 

This is a peer reviewed paper 

Please cite as : Botchu R: Ipsilateral Distal Radius, Ulna And Proximal Ulna Fracture: A Case Report

J.Orthopaedics 2006;3(2)e11

URL: http://www.jortho.org/2006/3/2/e11

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