A rare case presentation of monteggia variant fracture treated by Boyd’s approach: A case report and review of literature

Abstract

Complex elbow fractures are among the most difficult to treat due to the multiple articulations requiring reduction and the density of neurovascular structures limiting exposure. Frequently multiple approaches are required to access all bones involved without sacrificing important surrounding structures. Some of the most complex injuries include fractures of the olecranon, radial head, and coronoid arising from fracture/disruptions of the elbow. In these instances, the ulno-humeral, radio-capitellar, and proximal radioulnar joints are all disrupted and require visualization for appropriate treatment. Boyd first described a single-incision approach that allowed access to all these joints safely in 1940. This is a very versatile approach for treating elbow trauma that otherwise would require multiple incisions. With appropriate technique, the surrounding neurovasculature can also be preserved. The Boyd’s approach, however, fell out of favor given reports of synostosis. In this case report we are presenting a case of Proximal One Third Ulna Shaft fracture with radial neck fracture treated with 3.5 Dynamic Compression Plate in bridge mode for ulna and Radial Head Plate 2mm by Boyd’s approach and having functional range of motion without any active complaints in a one year follow up.