Paediatric chronic Monteggia Bado III fracture: how to avoid and treat

Samenvatting

Abstract Paediatric Monteggia fracture is misdiagnosed in 28% of cases, with possible functional impairment in delayed diagnosis. Assessment of the radiocapitellar alignment on both anteroposterior and lateral views of the elbow is imperative, especially when an apparently isolated ulnar fracture is present. Although Bado I injuries are the most common and diagnosed on lateral radiographs, type III injuries often go unnoticed due to inadequate examination of the anteroposterior view. We present a case of a 6-year-old female patient with a neglected Monteggia fracture (Bado III). The patient underwent surgery 10 months after initial trauma, involving open reduction of the radial head, repair of the annular ligament, and proximal ulnar osteotomy. At 1 year follow-up, the patient achieved a QuickDASH of 0. This case highlights the importance of early recognition and appropriate imaging evaluation, while demonstrating that satisfactory outcomes can be achieved in chronic cases with proper surgical management.