Posterior Interosseous Nerve Injury From Chronic Monteggia Fracture Dislocation Requiring Nerve Reconstruction

Monteggia fracture-dislocations are rare elbow injuries in the pediatric population. Multiple case reports have described posterior interosseous nerve (PIN) palsies in the setting of Monteggia fracture-dislocations, usually due to stretch neuropraxia. In this report of a Bado Type III Monteggia frac...

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Bibliographic Details
Main Authors: John Bartoletta, MD, Raymond Tse, MD, Suzanne Steinman, MD
Format: Article
Language:English
Published: Elsevier 2025-05-01
Series:Journal of the Pediatric Orthopaedic Society of North America
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Online Access:http://www.sciencedirect.com/science/article/pii/S2768276525000203
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Summary:Monteggia fracture-dislocations are rare elbow injuries in the pediatric population. Multiple case reports have described posterior interosseous nerve (PIN) palsies in the setting of Monteggia fracture-dislocations, usually due to stretch neuropraxia. In this report of a Bado Type III Monteggia fracture-dislocations with delayed diagnosis of an entrapped PIN, we highlight the importance of timely diagnosis. Surgical reconstruction using a sural nerve autograft was required when the PIN was found to be entrapped in the radiocapitellar joint and encircling the radial neck. Key Concepts: (1) Monteggia fracture-dislocations are rare elbow injuries in the pediatric population and can be missed. (2) The orthopaedic surgeon should have heightened suspicion for a posterior interosseous nerve palsy in Bado Type III Monteggia fracture-dislocations. (3) If a posterior interosseous nerve palsy is identified at the time of injury and reduction is difficult, we should consider nerve exploration as it may be entrapped in the joint.
ISSN:2768-2765