Median nerve palsy in a Monteggia fracture with anteromedial radial head dislocation: a case report

Nerve injury associated with Monteggia fractures is uncommon, and median nerve palsy, particularly at a level higher than the anterior interosseous nerve, has been rarely reported. Herein, we present the case of a 24-year-old woman who sustained a Monteggia fracture after falling from a bicycle. Because her median nerve function was impaired on physical examination, emergency surgery was planned. Preoperative radiographs revealed a midshaft ulnar fracture with a severely displaced anteromedial radial head, which was suspected to be impinging on the median nerve. Closed reduction of the radial head, followed by open reduction and internal fixation of the ulna, was performed. Subsequently, the neurologic deficit was resolved, with full recovery of function within 8 weeks. This case highlights the importance of recognizing atypical nerve involvement and expands the clinical spectrum of Monteggia fractures.