$monteggia fracture malunion following misdiagnosis$

$monteggia fracture malunion following misdiagnosis$

$monteggia fracture malunion following misdiagnosis$

Monteggia Fracture Malunion Following Misdiagnosis: A Critical Analysis

A Monteggia fracture with posterior dislocation of the radial head is a complex injury that requires prompt diagnosis and treatment to prevent long-term complications, including malunion. However, misdiagnosis can occur if healthcare providers are not familiar with the characteristics of this injury or if they rely too heavily on imaging studies alone.

In children, Monteggia fractures typically involve a fracture of the proximal ulna shaft with posterior displacement of the radial head, which can lead to pronation injuries of the forearm (1). If left untreated, these fractures can result in persistent posterior interosseous nerve palsy, as seen in a recent case report involving a child with a chronic type I Monteggia fracture-dislocation (2).

Adults with anterior Monteggia fractures also require urgent treatment to prevent malunion and long-term complications. A study published in the Journal of Orthopaedic Trauma found that surgically treated anterior Monteggia fractures in skeletally mature patients had good outcomes at long-term follow-up, but that nonunion rates were higher than expected (3).

The annular ligament plays a critical role in the pathophysiology of pediatric Monteggia fractures. In a recent study published in the Journal of Pediatric Orthopaedics, researchers found that the annular ligament was damaged or torn in all cases of pediatric Monteggia fracture, suggesting that this structure may be more susceptible to injury than previously thought (4).

In some cases, patients with ulnar fractures may experience late radial head dislocation, a condition known as delayed Monteggia fracture. This is often seen in adults and can lead to chronic pain and limited mobility of the elbow joint (5). A recent study published in the Journal of Orthopaedic Trauma found that delayed Monteggia fractures were associated with increased rates of malunion and nonunion compared to acute injuries (6).

When diagnosing a Monteggia fracture, it is essential to consider the patient's symptoms, physical examination findings, and imaging studies. The position of the elbow when immobilized depends on the fracture pattern, as described earlier (7). An image intensifier should be available with real-time and static images to verify anatomic reduction of the fracture and congruent relationship of the radiohumeroulnar joint.

Treatment of a Monteggia fracture typically involves closed reduction and splinting, but may require surgical intervention if there is malunion or nonunion. Closed reduction in children is easiest when performed with procedural sedation or general anesthesia (8). Pediatric patients should undergo emergency closed reduction and splint application, while adult patients can be treated on an outpatient basis.

Intravenous antibiotics should be administered to patients with open fractures, and open wounds should be irrigated with sterile saline solution and dressed with sterile, moist gauze. Patients with open fractures should also have their tetanus immunization status determined and addressed as indicated (9). Pain management is essential in the immediate period following injury, and sedation may be necessary to facilitate closed reduction or surgical intervention.

In conclusion, Monteggia fracture malunion following misdiagnosis can lead to long-term complications and decreased outcomes. Healthcare providers must be aware of the characteristics of this injury and use a combination of clinical examination findings and imaging studies to make an accurate diagnosis. Prompt treatment is essential to prevent malunion and ensure optimal outcomes for patients with Monteggia fractures.

$monteggia fracture malunion following misdiagnosis$