Radial head anterior dislocation and ulna bowing in children

A 11 year old boy is examined three days after going to the emergency room, in consultation with orthopedic surgery for right elbow pain after a fall on the hand. The clinical examination revealed edema of the external part of the elbow with a deficit in flexion and supination. X-rays revealed anterior dislocation of the head radial associated with plastic deformation of the ulna (A). It´s about an equivalent type 1 Monteggia lesion according to the Bado classification. The line of Mubarak highlights the deformation plastic of the ulna on x-rays of profile. The treatment consisted of a closed orthopedic reduction under sedation by external maneuvers directed in the opposite direction of the plastic deformation of the ulna and dislocation of the radial head under scopic control which was satisfactory. Patient was immobilized in a long arm cast in 90 degrees of flexion and supination and followed closely radiographically for 2 weeks to ensure maintenance of radial head reduction (B). After four weeks the patient begins functional rehabilitation. The two-month check showed a painless stable elbow with symmetrical supination and flexion. Evolution is pejorative in the absence of a early reduction. A Radial neuropathy can also occur in the longer term by compression, hence the importance of early diagnosis.