Date: Wed, 3 Sep 2003 06:51:41 +0545

Subject: Missed elbow injury ???

From: Dr. M. P. Shrivastava

Dear all,

A young 20 years male medical student had been operated for cubitus valgus deformity of his left elbow about a month ago . The pre-operative x-rays were not done and the patient was not having any neurogical disorder with full flexion, extension , supination and pronation movements. The patient was instructed to do active movements of the elbow after 3 weeks.

About 2 days ago the patient experienced severe pain around the eblow with restricted flexion and extension movements but with almost full supination and pronation movements. Somehow the patient was referred to me and after doing several x-rays including the normal right elbow, it appears to me that the patient suffered from "missed Monteggia fracture dislocation" for which unnecessarily wedge osteotomy was done.

Although the patient's parents did not give any history of injury during his childhood. I have put the limb into sling and have asked the patient not to do any kind of exercise for another few weeks till the osteotomized site heals properly. I am attaching the images. Kindly give your valuable suggestions /opinions regarding this case.

Dr. M. P. Shrivastava
Consultant Orthopaedic Surgeon
Nepal Medical College Teaching Hospital
Jorpati, Kathmandu, Nepal

Date: Wed, 3 Sep 2003 07:46:01 -0400

From: James Carr

The x-rays were a bit fuzzy. Are you sure he did not have a congenital radial head dislocation. They can give you a valgus elbow with pain.

Jim Carr