Monteggia fracture dislocation is a combination of ulnar frac- ture and radial head dislocation at the radio-capitellar joint. Pedi- atric Monteggia fracture-dislocation is a commonly missed injury affecting the elbow joint [1-5]. This injury usually involves an obvi- ous ulna fracture, however, in some cases the ulna fracture is not easily detected in the elbow radiographs [2,6]. Mubarak describes a Monteggia equivalent injury involving dislocation of the radial head in addition to subtle radiographic plastic deformation of the ulna [7]. In fact, Mubarak sheds doubt on the mere existence of an isolated radio-capitellar dislocation [7]. Deformation of the ul- nar bow has therefore been implicated in the etiology of all cases of radio-capitellar instability in the pediatric patients [7,8]. In the clinic, or the emergency room, these injuries can be easily missed, and reduction of the radial head can prove to be challenging. In most cases, the radial head will spontaneously reduce at the radio- capitellar joint with ulnar fracture reduction. In cases with failed closed reduction of the head radius, open reduction of the radial head is generally indicated which can be associated with many complications including elbow stiffness and recurrence of disloca- tion/subluxation. The goal of this technique paper is to describe an alternative technique for reducing radial head in cases of Mon- teggia fracture dislocation that fail to reduce after ulnar fracture reduction. Two case examples will be presented that describe this principle. |
