Pediatric Tiemdjo type IV transolecranon fracture-dislocation with medial collateral ligament rupture: Case report with brief literature context

Introduction

Pediatric transolecranon fracture-dislocations (TOFD) are uncommon and often underdiagnosed. Type IV injuries, according to the Tiemdjo classification, include associated soft-tissue or bony lesions, further complicating treatment. The aim of this report is to present a pediatric case of Tiemdjo type IV TOFD with concomitant medial collateral ligament (MCL) rupture and highlight the clinical and surgical implications.

Presentation of case

An 11-year-old male sustained a displaced transverse olecranon fracture with anterior ulnohumeral dislocation after a fall. Clinical and intraoperative evaluation confirmed MCL rupture. Surgical fixation was performed using K-wires and a tension-band construct, and the MCL was repaired with a suture anchor. The patient achieved full range of motion and excellent function (MEPS 100) by 6 months postoperatively.

Discussion

TOFDs are distinct from Monteggia lesions by preserving radioulnar alignment. Type IV injuries, particularly when combined with ligamentous disruption, are uncommon. This case underscores the importance of addressing both bony and ligamentous components. Tension-band wiring remains suitable for simple transverse fractures in skeletally immature patients, facilitating early motion.

Conclusion

Recognition of TOFD and associated soft-tissue injury is essential. Early surgical intervention with anatomical reduction and ligament repair can achieve excellent functional outcomes in pediatric patients.