Open Monteggia Fracture with Massive Vascular Damage - from ER to Surgery

Introduction: Elbow dislocation in adults due to trauma account for 25% of joint injuries. Open monteggia fracture according to Bado is considered rare adults, moreover a severe vascular injury in adults varies 0.3-12.5% of the cases.

Patient Concern and Diagnoses: A 46 year old male patient who suffered an open Elbow fracture due to a motor vehicle accident, at the Emergency Room the patient had an open wound with deformed elbow along with signs of ischemia. On X-ray, type 1 monteggia was diagnosed.

Intervention and Outcomes: A joined team of orthopedic and vascular surgeons operated the patient, restore the ulnar length and stability using 1/3 tubular plating along with the dislocated radial head and repair the vascular damage. The patient regained a functional elbow joint.

Lessons: When dealing with an unstable fracture together with vascular compromise condition one must kept in mind that time is on the essence. We recommend using doppler US in the ER, and enter the operating room with a joined team of orthopedic and vascular surgeons.