Presentation
Fall from a stepladder onto the outstretched hand.
Patient Data
Radiographs revealed a complex elbow fracture. There is a proximal ulna fracture associated with a radial head dislocation, which characterizes a Monteggia fracture-dislocation.
The Monteggia fracture can be classified as a Bado type III: there is a metaphyseal ulnar fracture associated with a lateral radius dislocation.
Furthermore, there is a radial head fracture and a posterior elbow subluxation. There is elbow joint effusion and the sail sign is noted.
Case Discussion
This case represents a complex fracture of the elbow.
There is a Monteggia fracture-dislocation (Bado type III).
However, it could also be considered that the ulnar fracture involves the coronoid process, which along the radial head fracture and the posterior elbow subluxation would characterize a terrible triad of the elbow.
The orthopedic surgeon team discussed the case and agreed there was a whole segmental ulnar fracture that isolates the coronoid process, but the coronoid process itself was preserved, thus the case was managed as a Monteggia type III fracture with an associated radial head fracture.
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