Medial Radial Head Dislocation Associated with a Proximal Olecranon Fracture: A Bado Type V?

The Monteggia fracture is relatively rare. We present an unreported configuration of a traumatic olecranon fracture with a concomitant medial radial head dislocation in a 3-year-old male. This injury was initially missed and required a subsequent operative intervention. Following surgery, there was evident fracture union, articular congruency, and a full functional recovery. Medial radial head dislocation is not accounted for in the Bado (1967) classification of the Monteggia lesion and hence we propose the addition of a Bado V category. 1. Introduction The Monteggia fracture is relatively rare in the paediatric population and has been classified by Bado [1] into four variants. We present the case of a three-year-old boy who sustained an olecranon fracture with a concomitant medial dislocation of the radial head. We propose the addition of a 5th variant to the Bado classification to encompass medial and anteromedial radial head dislocations. 2. Case Report The patient’s guardian gave informed consent prior to the child being included into the study. This study was authorized by the local ethical committee and was performed in accordance with the Ethical standards of the 1964 Declaration of Helsinki as revised in 2000. A three-year-old boy fell whilst running in a playground. He presented to the emergency department at his local hospital and was complaining of a painful elbow. On examination, his elbow was noted to be extremely swollen and has adapted a flexed posture with maximal apprehension and reluctance at any attempt to mobilise its joints in all directions. Plain radiographs were obtained (Figures 1 and 2) which confirmed an olecranon fracture in the presence of a radial head dislocation. The radial head dislocation was not initially recognised by the assessing casualty doctor. The elbow was immobilised in an above elbow back slab and the patient was discharged home with a planned follow-up in fracture clinic where he was seen by an orthopaedic registrar 13 days after the injury. Repeat radiographs were obtained (Figures 3 and 4) and the medial radial head dislocation was confirmed. Figure 1: Lateral radiograph of three-year-old boy showing olecranon fracture. Figure 2: Anterioposterior radiograph: note the bony fragment and the medial radial head dislocation. Figure 3: Repeat lateral radiograph of the same elbow twelve days later. The olecranon fracture is more defined. Figure 4: Anterioposterior radiograph of the same elbow twelve days after injury. Bony fragment still visible. Due to the nature of this unusual presentation; the child was