Median Nerve Palsy following Elastic Stable Intramedullary Nailing of a Monteggia Fracture: An Unusual Case and Review of the Literature

Abstract

Monteggia fractures are rare in children, and subtle radial head dislocations, with minor plastic deformation of the ulna, may be missed in up to a third of cases. Complications of Monteggia fractures-dislocations include persistent radial head dislocation, forearm deformity, elbow stiffness, and nerve palsies at the time of presentation. An unusual case of median nerve palsy following elastic stable intramedullary nailing of a type I Monteggia lesion in a 6-year-old girl is presented, and we highlight that, although most nerve palsies associated with a Monteggia fracture-dislocations are treated expectantly in children, early intervention here probably provided the best outcome.

Figure 1

Lateral (a) and oblique (b) radiographs of a right type I Monteggia fracture-dislocation.

Figure 2

Postoperative anteroposterior (a) and lateral (b) radiographs of the right forearm with a 2 mm titanium elastic nail in the ulna. Diaphyseal ulna fragment not reduced.

Figure 3

Anteroposterior (a) and lateral (b) radiographs of right forearm two weeks after exploration.

Figure 4

Anteroposterior (a) and lateral (b) radiographs of right forearm at six months showing fracture union and remodelling.

Figure 5

Clinical photographs demonstrating range of movement at nine months of the forearms in pronation (a), supination with flexion of 45 degrees (b) and 90 degrees (c), elbow extension (d), elbow flexion (e), and full median nerve function (f, g).