NEGLECTED MONTEGGIA FRACTURE-DISLOCATION IN AN ADOLESCENT: CLOSED REDUCTION OF THE RADIAL HEAD FOLLOWING ULNAR OSTEOTOMY

Neglected Monteggia fracture-dislocations represent a therapeutic challenge due to the difficulties associated with radial head reduction and restoration of elbow function. We report the case of a 16-year-old adolescent presenting with a Bado type I Monteggia fracture-dislocation that had remained untreated for three months following loss to follow-up. Clinical examination revealed limited elbow flexion and complete loss of forearm pronation and supination. Radiographs demonstrated ulnar malunion associated with persistent radial head dislocation. A transverse ulnar osteotomy followed by realignment and fixation with a dynamic compression plate (DCP) allowed indirect reduction of the radial head without surgical exposure of the joint. Temporary humeroradial pin fixation was performed to maintain the reduction. At the three-month postoperative follow-up, the patient showed a favorable outcome, with radiographic union of the ulnar osteotomy, maintained radiocapitellar alignment, and full recovery of elbow flexion-extension and forearm pronation-supination. This case highlights the feasibility of indirect radial head reduction following ulnar realignment in selected patients with neglected Monteggia injuries. However, the success of this approach depends on the anatomical characteristics of the injury and the reducibility of the radial head. Longer-term follow-up is required to assess the maintenance of reduction and the durability of functional recovery.