Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2021; 9(30): 9228-9235
Published online Oct 26, 2021. doi: 10.12998/wjcc.v9.i30.9228
Monteggia type-I equivalent fracture in a fourteen-month-old child: A case report
Ming-Lei Li, Wei-Zheng Zhou, Lian-Yong Li, Qi-Wei Li
Ming-Lei Li, Wei-Zheng Zhou, Lian-Yong Li, Qi-Wei Li, Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Author contributions: Li ML conceived the study and wrote the manuscript; Zhou WZ acquired the patient’s information and helped draft the manuscript; Li LY participated in the design and coordination and helped draft the manuscript; Li QW is the senior author who treated the patient and revised the manuscript; All of the authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi-Wei Li, MD, Chief Doctor, Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China. 18940251689@163.com
Received: May 26, 2021
Peer-review started: May 26, 2021
First decision: July 15, 2021
Revised: July 17, 2021
Accepted: September 8, 2021
Article in press: September 8, 2021
Published online: October 26, 2021
Abstract
BACKGROUND

Monteggia and equivalent lesions are relatively rare but result in severe injuries in childhood, typically affecting children between 4 and 10 years old. The diagnosis and treatment of an equivalent Monteggia lesion is more complicated than those of a typical Monteggia fracture. This type of lesion may be challenging and may lead to serious complications if not treated properly. Pediatric Monteggia equivalent type I lesions have been reported in a few reports, all of which the patients were all over 4 years old.

CASE SUMMARY

A 14-mo-old boy was referred to our clinic after falling from his bed 10 d prior. With regard to the clinical examination, an obvious swollen and angular deformity was noted on his right forearm. Plain radiographs and reconstructed computed tomography scans showed a Monteggia type I fracture and dislocation. Magnetic resonance imaging (MRI) confirmed a type I Monteggia equivalent lesion consisting of ulnar fracture and Salter-Harris type I injury in the proximal radius. The radial head was still in the joint, and only the radial metaphysis was displaced anteriorly. Open reduction and pinning of both displaced radial and ulnar fractures achieved an excellent result with full function.

CONCLUSION

We recommend MRI examination or arthrography during reduction, especially if the secondary ossification center has not appeared.

Keywords: Children, Monteggia fracture-dislocation, Monteggia equivalent lesion, Radial neck fracture, Ulnar fracture, Case report

Core Tip: We reviewed a case of Monteggia type I equivalent fracture in a 14-mo-old child. This is the youngest patient to suffer from this injury. For patients aged less than 5 years, plain radiograph and reconstructed computed tomography scans cannot distinguish Monteggia fractures and Monteggia equivalent fractures in patients with unossified radial heads. As a result, fractures may be misdiagnosed or neglected, leading to poor clinical and radiographic results. Therefore, magnetic resonance imaging (MRI) should be routinely performed. We recommended MRI examination or arthrography during reduction if cartilage fracture is suspected, especially if the secondary ossification center has not appeared.