Rare Monteggia Type IV Fracture With Posterior Radial Head Dislocation and Concomitant Glenoid Fracture: A Case Report

TL;DR

A rare Monteggia fracture with posterior radial head dislocation and a missed glenoid fracture was successfully treated with surgery and rehabilitation.

Contribution

Presents a rare Monteggia Type IV variant with posterior radial head dislocation and concomitant glenoid fracture, expanding the known injury spectrum.

Findings

Salvage radial head resection improved elbow and shoulder function in a complex Monteggia fracture case.

Posterior radial head dislocation was successfully managed despite initial misdiagnosis.

Patient achieved significant functional recovery with pain-free mobility after six months.

Abstract

Monteggia fractures are uncommon ulnar fractures with associated radial head dislocation, which are classified into four Bado types. Type IV lesions, involving both forearm fractures with anterior radial head dislocation, are particularly rare. This case describes an exceptionally rare variant in a 23-year-old male patient following a motor vehicle accident: a Bado Type IV Monteggia fracture with posterior radial head dislocation, accompanied by an ipsilateral Ideberg type III glenoid fracture, which was initially missed. Despite prior open reduction and internal fixation (ORIF) of the forearm shafts and non-operative glenoid management, the patient presented to our department with significant elbow and shoulder stiffness and a persistent posterior radial head dislocation. Salvage radial head resection via a lateral Kocher approach, followed by intensive rehabilitation, yielded significant functional recovery at six months, including full elbow range of motion (except for 40° pronation) and marked improvement in shoulder mobility. The patient remained pain-free. This case underscores the diagnostic challenges of atypical Monteggia fracture patterns in complex trauma and supports radial head resection as a viable salvage option in chronic, symptomatic dislocations, even in this unique variant, thus expanding the current understanding of the spectrum of Monteggia injuries.

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