paediatric
Pediatric Monteggia Fracture-Dislocation
advanced
6 min
28 marks
6 questions
Clinical Scenario
A 6-year-old boy presents after falling from playground equipment onto his outstretched right arm. He complains of pain in the elbow and forearm. On examination, there is swelling and tenderness over the proximal forearm. The elbow appears slightly prominent anteriorly. He is reluctant to supinate or pronate. Finger movements are normal. Pulses are present.
AP and lateral radiographs of the right forearm in a 6-year-old child demonstrating a Bado Type I Monteggia lesion. There is an anteriorly angulated proximal ulna fracture with anterior dislocation of the radial head. The radiocapitellar line does not pass through the capitellum on the lateral view, confirming radial head dislocation. The apex of the ulna fracture is anterior, consistent with the direction of radial head dislocation.
Source: Monteggia Fracture in Child: Radial Head Dislocation • PMC4150939 • CC-BY
Questions
Question 1 (4 marks)
Describe the radiographic findings and Bado classification.
Question 2 (5 marks)
What is the mechanism of injury and why is this injury commonly missed?
Question 3 (6 marks)
Describe the treatment algorithm and surgical technique.
Question 4 (5 marks)
What are the complications of Monteggia fractures?
Question 5 (4 marks)
How do you manage a chronic missed Monteggia lesion?
Question 6 (4 marks)
What are the key principles for imaging the pediatric forearm?
Exam Day Cheat Sheet
Must Mention
- •Bado classification (I anterior 70%, II posterior, III lateral, IV + radius)
- •Radiocapitellar line on ALL forearm X-rays
- •Apex direction = RH dislocation direction
- •Anatomic ulna reduction = RH reduces
- •PIN at risk in Type III
- •Chronic missed = reconstruction if <10yo
Common Pitfalls
- •Missing Bado types
- •No radiocapitellar line
- •Wrong apex-dislocation link
- •Missing PIN injury
- •Wrong chronic management
- •No full imaging principle