What are the treatment options for a 4 years child with montaggia fracture dislocation left elbow with PIN injury?

Nonoperative closed reduction indications more common and successful in children must ensure stabilty and anatomic alignment of ulna fracture technique cast in supination for Bado I and III Operative ORIF of ulna shaft fracture indications acute fractures which are open or unstable (long oblique) comminuted fractures most Monteggia fractures in adults are treated surgically ORIF of ulna shaft fracture, open reduction of radial head indications failure to reduce radial head with ORIF of ulnar shaft only ensure ulnar reduction is correct complex injury pattern IM Nailing of ulna indications transverse or short oblique fracture

CLosed reduction and closed/mini open reduction and internal fixation for ulna. Confirm congruent reduction. Immobilisation, closed observation for the maintainance of  reduction and followup for monitoring the nerve recovery. Failur of PIN to recover should be further investigated with NCS and necessory treatment is to be advised.

close or open reduction of Radial Head and per cutenous K- wire fixation then application of long arm back slab for 4-6 weeks. Then the plaster and K-wire remove.

The radial head dislocation should be reduced on an emergency basis. Closed reduction under sedation should be performed within 6-8 hours of the injury. This is usually achieved with supination of the forearm, but it may require traction and direct pressure on the radial head. If closed reduction is unsuccessful, the patient should be taken to the operating room (OR) within this same time frame for open reduction. Delay in reduction of the radius may lead to permanent articular damage, further nerve injury, or both.

closed reduction of ulna and radial head dislocation and long arm casting

Indications

§    Bado Types I-III with

§radial head is stable following reduction

§length stable ulnar fracture pattern

Reduction technique

§    reduction technique uses traction

§    radial head will reduce spontaneously with reduction of the ulna and restoration of ulnar length

Immobilization

§     immobilize in 110° of flexion and full supination for Types I and III to tighten interosseous membrane and relax biceps tendon 

stable fixation of the ulna in slight extension by external fixatôr

Closed reduction of the fractured ulna and upon reducing the fracture the dislocated proximal part of radius will be reduced. Then casting a follow up for PIN  which mostly is neuropraxia due to compression by dislocated radius 

open ion internal fixation with nerve exploration 

close reduction and internal fixation with close followup for Neurological conditon

closed reduction and if the ulna is still not reduction ,we have to ORIF and for pin injury we need observation and with splinting and NSAIDS .

close reduction /open reduction ulna   close reduction radial head, long arm cast and observation for pi  nerve recovery