Breaking the elbow: Uncommon coexistence of olecranon and radial head fractures in children – A four-case analysis

Combined fractures of the olecranon and radial head in children are exceptionally uncommon. Their simultaneous presentation may represent a previously unclassified Monteggia equivalent, underscoring the need for greater clinical awareness. Early recognition is essential to ensure appropriate management and to prevent long-term functional impairment. We report four pediatric cases of concurrent olecranon and radial head fractures sustained after a fall onto a flexed elbow. All patients underwent surgical treatment consisting of cerclage wiring (CW) of the olecranon and elastic stable intramedullary nailing (ESIN) of the radial head. Post-operative clinical and radiological evaluations were performed regularly over a 6-month period. Radiographic union was achieved in all patients by post-operative day 30, allowing hardware removal by day 60. By day 90, all children had recovered a full, pain-free range of motion with no deformity or instability. No post-operative complications were observed. Although individually common in pediatric trauma, the coexistence of olecranon and radial head fractures is rare and may be overlooked without careful assessment. The mechanism, typically a fall onto a flexed elbow, can generate forces sufficient to produce this combined pattern. The excellent results observed in all four cases support the effectiveness of CW and ESIN as complementary fixation methods, providing stable reduction, promoting early healing, and enabling rapid functional recovery. The consistent presentation and outcomes suggest that this injury pattern falls within the spectrum of Monteggia equivalents and merits formal classification to guide diagnostic and therapeutic strategies. This series highlights a rare but clinically significant combination of pediatric olecranon and radial head fractures. When promptly identified and surgically treated, outcomes are uniformly favorable. Recognition of this pattern as a potential Monteggia equivalent may improve management and stimulate further study.