Beware the ides of Morel-Lavallée: A lesion to consider when diagnosing trauma patients.

Morel-Lavallée lesions are post-traumatic, internal degloving injuries associated with substantial patient mortality that are frequently undetected due to often presenting days to weeks after initial injury. Delay of diagnosis can perpetuate complications such as expansion and infection (Mutluoglu et al., 2021 [1]). A 46 year old male presented with a Morel-Lavallée lesion to the left anterior thigh and hip two weeks after receiving emergency care after an accident where he was thrown from his motorcycle. It is paramount that physicians consider this diagnosis when evaluating post-traumatic patients to mitigate lesion expansion, overlying skin necrosis, underlying fracture exposure and subsequent infection.

Adult Bado type I Monteggia fracture dislocation: A case report.

INTRODUCTION: Fractures of the proximal ulnar shaft accompanied by dislocation of the radial head have been described as "Monteggia fracture-dislocations," since the early nineteenth century. In 1967 Bado further classified these Monteggia fractures into four subtypes, based largely on the direction of the radial head dislocation (Bado, 1967). Despite being frequently discussed in the literature, Monteggia fracture dislocations are rare and represent only 0.7% of elbow fracture-dislocations in adults (Papaioannou et al., 2018). In adults, Bado type I lesions, where the radial head is displaced anteriorly are rarer still, and few cases have been reported in the literature (Papaioannou et al., 2018; Suarez et al., 2016; Egol et al., 2005; Saidi et al., 2018; Wong et al., 2015). CASE PRESENTATION: We present here the case of a 55-year-old male presenting with a Bado type I Monteggia fracture dislocation, resulting from direct trauma to the posterior ulnar surface of his arm. He was treated with ORIF five days after the injury, and by hospital discharge had had 75% active range of motion of his elbow to flexion and extension. CONCLUSION: We present this case of a rare adult fracture subtype with a unique mechanism to add to a paucity of existing literature on such cases and the approach to their care. These fracture-dislocations can be easy to miss because the radial dislocation can be subtle and overshadowed by the more obvious ulnar fracture. This case report hopes to contribute to the expedient recognition of this fracture dislocation syndrome, which is crucial to the preservation of range of motion and arm function for these patients.