Robert», la partie de l'art médical qui a pour objet - sotcot

i. introduCtionThe association of a Monteggia fracture dislocationand a lesion of the lower extremity of radius,is very rare and there are few reported cases in theliterature [1-3]. The described injuries in childrenare Galeazzi fracture dislocation or fracture-separationof the distal epiphysis of the radius [2, 4, 5].Combined Monteggia injury and isolated metaphysealfracture of the radius in the same forearmhad never been described.Monteggia fracture dislocation associated with ipsilateral distal radial metaphyseal fracture. A case reportand the extremity was immobilized in an abovethe-elbowplaster cast with the elbow in 90 degreesof flexion and neutral position of the forearm(Fig 2).Tun Orthop 2008, Vol 1, N° 2ii. Case reportAn eleven-year-old boy fell from a height of aboutone meter and sustained an injury of the left forearm.When the child was firstly seen, he wasunable to describe the mechanism of the trauma,but it seems that the forearm was in pronation. Hehad a severe volar angular deformity in the distalpart of the forearm without any neurovascular deficitor cutaneous lesion. Motion of the elbow andwrist was very painful and restricted.Roentgenograms showed an anterior dislocationof the head of the radius and a fracture of themiddle third of the ulnar diaphysis with volar angulation.In addition, there was a fracture throughthe radial metaphysis with posterior displacementbut without dislocation of the distal radio-ulnarjoint (Fig 1).Figure 2: Osteo-articular reduction under general anaesthesia and immobilizationwith a plaster castThe patient remained in the cast for 6 weeks andat the end of this time, bone union had occurred.At 20 months follow-up, there had been nogrowth disturbance (Fig 3) and the patient had agood function of the wrist and the elbow; pronationand supination were normal.Figure 1: Monteggia lesion associated to distal metaphyseal radial fractureThe fracture was manipulated under generalanaesthesia and image intensification. An adequatereduction of both fractures was obtainedFigure 3: X-Rays at 20 months follow-up: Good bone alignementiii. disCussionIn 1814, Monteggia described two cases of fractureof the proximal part of the ulna with anterior203