Monteggia Fracture-Dislocation Associated with Proximal and Distal Radioulnar Joint Instability: A Case Report

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The Essex-Lopresti injury is a complex injury of the forearm consisting of rupture of the interosseous membrane and disruption of the distal radioulnar joint with radial head fracture1. The Monteggia injury involves a fracture of the proximal aspect of the ulna with dislocation of the proximal radioulnar joint (with or without fracture of the radial head), as classified by Bado2. Potential complications of the Monteggia injury include forearm deformity, elbow stiffness, persistent dislocation of the radial head, and nerve palsy3,4. Persistent radial head dislocations associated with Monteggia fracture-dislocation have been described in the past as being due to entrapment of structures or as being caused by, such as the annular ligament and anterior capsule5, the biceps tendon6, the radial nerve7, and the median nerve8, relative malalignment of the ulna9,10. We present the unusual case of a patient with persistent radial head dislocation following a Bado type-I Monteggia fracture (anterior dislocation of the radial head) with associated instability of the distal radioulnar joint. The complete longitudinal instability of the forearm in this patient represented a variation of the Essex-Lopresti injury. Our patient was informed that data concerning the case would be submitted for publication, and he consented.
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