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REPORT |
Ipsilateral
Distal Radius, Ulna And Proximal Ulna Fracture: A Case Report
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* 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 |
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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
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Type I - Anterior dislocation of the radial
head and fracture of the ulnar diaphysis at any level with
anterior angulation. Most common fracture pattern.
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Type II - Posterior dislocation of the
radial head and fracture of the ulnar diaphysis with posterior
angulation. Rare in children.
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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:
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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 :
-
Cole WH.
Primary Tumours of Patella. J Bone Joint Surg 1925; 23:
637-654.
-
Deepak
Chaudhary, Naval Bhatia, Abrar Ahmed, Chopra R K. Unicameral
bone cyst of the Patella. Orthopaedics 2000; 12: 1285-1286.
-
Ferguson PC,
Griffin AM, Bell RS. Primary Patellar Tumours. Clin Orthop
1997; 336: 199-204.
-
Jucker C,
Cuneo L. Juvenile solitary bone cysts of the patella.
Presentation of a case report. Ann Radiol Diagn (Bologna).
1962; 35: 192-194.
-
Linda M Parman,
Mark D Murphey. Alphabet Soup: Cystic Lesions of Bone.
Seminars in Musculoskeletal Radiology 2000; 4(1): 89-101
-
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.
-
Mercuri M,
Casadei R. Patellar Tumours. Clin Orthop 2001; 389: 35-46.
-
Saglik Y, Ucar
DH, Yildiz HY, Dogan M. Unicameral bone cyst of the patella. A
case report. Int Orthop 1995; 19(5): 280.281.
-
Schultz E,
Greenspan A. Case report 378: Simple bone cyst. Skeletal
Radiol 1986; 15(5): 405-407.
-
Weintroub S,
Salama R, Baratz M, Papo I, Weissman SL. Unicameral bone cyst
of the Patella. Clin Orthop 1979; 140: 158-161.
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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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