584 THE JOURNAL OF BONE AND JOINT SURGERY Case report Case report AN UNUSUAL MONTEGGIA TYPE-I EQUIVALENT FRACTURE IN A CHILD A. A. Faundez, D. Ceroni, A. Kaelin From the Geneva Children’s Hospital, Switzerland A. A. Faundez, MD, Chief Resident D. Ceroni, MD, Chief Resident A. Kaelin, MD, PD, Professor of Orthopaedic Surgery Clinique d’Orthopédie Pédiatrique, Hôpitaux Universitaires de Genève, 24 rue Micheli-du-Crest, CH-1211 Geneva, Switzerland. Correspondence should be sent to Dr D. Ceroni. ©2003 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.85B4.13204 $2.00 six-year-old girl sustained a Monteggia type-I equivalent fracture of the right forearm. We describe the method of treatment of this rare fracture and its outcome. J Bone Joint Surg [Br] 2003;85-B:584-6. Received 30 January 2002; Accepted 14 May 2002 Since the first description of the Monteggia fracture in 1814, 1 numerous classification systems have been pro- posed. 2-7 Bado 8 was the first to define four types according to the supposed mechanism of injury, and his classification remains the most frequently cited in the literature. It does not, however, describe the severity of the lesion nor does it have prognostic value, and sometimes it is difficult to cat- egorise unusual lesions. We present the case of a six-year- old girl who sustained a rare type-I equivalent fracture and describe our method of operative treatment. In our review of the literature only one other similar injury has been reported. 9 Case report A six-year-old girl was admitted after a fall from a height, landing on her outstretched right forearm. Her elbow was slightly swollen and painful but there were no signs of neurological or vascular injury. After the application of a temporary splint, anteroposterior (AP) and lateral radio- graphs of the forearm, including the wrist and elbow, were obtained (Fig. 1). An oblique fracture of the ulna at the junc- tion of the proximal and middle thirds was noted associated A with an anteriorly displaced fracture of the neck of the radius. The head remained in its normal relationship to the capitellum. We made the diagnosis of a Monteggia type-I equivalent fracture according to Bado’s classification. 8 The child underwent urgent temporary percutaneous K- wire stabilisation of the radial head (Fig. 2) followed by closed reduction and transmedullary fixation of the fractures of the ulna and radial neck. The wire which had initially sta- Fig. 1a Fig. 1b Radiographs showing a) the AP and b) the lateral views of the right forearm. There is an oblique fracture of the ulna suggesting an injury after a fall on the outstretched arm. The anteriorly displaced fracture of the neck of the ra- dius is visible on both radiographs. The head of the radius remains in place.