title: Percutaneous reduction and flexible intramedullary nailing for monteggia fracture in a skeletally mature patient.
abstract: BACKGROUND
  Monteggia lesions are defined as a fracture of the proximal ulna with an associated radial head dislocation. Management of these injuries varies depending upon the patient population, ranging from non-operative treatment with closed reduction and immobilization to surgical fixation. Percutaneous techniques of radial head reduction are often reserved for skeletally immature patients.
  
  
  METHODS
  In this case report, a 14-year-old female presented with left elbow pain three days after a fall. Radiographs and CT images from an outside hospital revealed a displaced left radial head fracture and a non-displaced proximal olecranon fracture, consistent with a Monteggia equivalent fracture. The patient underwent percutaneous reduction and internal fixation of the radial head with a flexible intramedullary nail (Metaizeau technique), and open reduction and internal fixation of the olecranon. She developed a 25 degree left elbow flexion contracture and, five months after her index procedure, underwent arthroscopic release and removal of hardware. The radial head reduction was near anatomic and she regained full extension.
  
  
  CONCLUSIONS
  This report demonstrates that percutaneous reduction with intramedullary nailing and fixation techniques can be performed successfully in skeletally mature patients.
  
  
  CONCLUSIONS
  Given their less invasive nature, we recommend attempting percutaneous interventions in some skeletally mature individuals for fracture reduction and fixation.
authors.affiliation: NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, NY 10003, USA. Electronic address: bryanbeutel@gmail.com.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Beutel
authors.affiliation: NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, NY 10003, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Klifto
authors.affiliation: NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, NY 10003, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Chu
keywords: Metaizeau; Monteggia; Percutaneous; Skeletally mature