Pachydermodactyly - A Case Report and Review of Literature.

INTRODUCTION: We report an extremely rare combination of Monteggia equivalent Type 1 lesion (diaphyseal ulna and radial neck fractures without dislocation) with ipsilateral radius shaft and distal radius fractures in a 13-year-old boy. There are only a few cases of Monteggia or Monteggia equivalent injury with ipsilateral forearm fractures in children, and injury pattern being reported by us is not only rare but also the only case reported, thus far to the best of our knowledge.

CASE REPORT: A 13-year-old, right-hand dominant boy presented in casualty with a history of fall 1 day back with pain, swelling and deformity in the left forearm with bleeding from the left forearm, and restriction of movement of fingers and thumb of the left hand. On examination, there was a wound of size 1.5 cm on the upper third-forearm over the ulnar aspect. No neurovascular deficit was present. X-rays were performed, which suggested Type I Monteggia fracture equivalent lesion (diaphyseal ulna and radial neck fractures without dislocation) with ipsilateral distal radius and radial shaft fractures. The patient was operated with toileting, debridement, and close reduction of proximal ulnar fracture with titanium elastic nail (TENS) Distal radius was managed by percutaneous fixation with two K-wires under the guidance of image intensifier, while the shaft of radius fracture was managed by close reduction and internal fixation with elastic TENS nail with a lateral entry point and radial neck fracture was managed by the Metaizeau technique. Follow-up of the patient showed subsequent union of all fractures with good functional outcome.

CONCLUSION: We have highlighted an extremely rare combination of injuries. Early recognition and prompt surgical intervention can lead to a satisfactory outcome, even in these complex injuries.