All Monteggia fracture-dislocations require an urgent orthopedic assessment. Reduction is always required. Delayed or missed diagnosis is the most frequent. Monteggia fractures account for approximately 1% to 2% of all forearm fractures. Distal forearm fractures are far more frequent than midshaft. Monteggia fracture-dislocations consist of a fracture of the ulnar shaft with concomitant dislocation of the radial head. The ulnar fracture is usually obvious.

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Rib fracture Sternal fracture. Forty-seven patients with Monteggia variants were followed for a mean of 8. Scaphoid Rolando Bennett’s Boxer’s Busch’s.

Monteggia fracture

To access free multiple choice questions on this topic, click here. Post—operative Rehabilitation Children should be placed in a well-molded long-arm cast after open or closed reduction. Log in Sign up. This indicates a need for operative correction. The Problem The Monteggia fracture, or fracture of the proximal third ulna with associated subluxation or dislocation of the radial head, in fact includes a wide variety of injuries to the proximal articulations between the humerus, radius, ulna, and the forearm axis of rotation.

Surgical goals include anatomic repair of the ulno-humeral articulation as well as the radiocapitellar joint. In adults, obtaining and maintaining ulnar fracture and radiocapitellar reduction via closed means is not usually possible. Dislocations of the radial head may stretch and injure the posterior interosseous nerve.

This is thought to be due to multiple influences, including the remodeling ability of small angle deformities, shorter healing time, and overall solidity of Monteggia fractures in children. HPI – Patient presented after a fall from a slide on his left arm. Pathophysiology The osseous forearm is composed of the radius and ulna bones. The most common operative repair is an ORIF.


Arthrography can aid in assessing radiocapitellar congruity in cases of non-ossified radial head.

Monteggia fracture-dislocations – Emergency Department

What are the potential complications associated with this injury? Basilar skull fracture Blowout fracture Mandibular fracture Nasal fracture Le Fort fracture of skull Zygomaticomaxillary complex fracture Zygoma fracture. Fracture variations were classified both by the Bado and the Jupiter sub-classification scheme for type 2 fractures. HPI – Fell from her height.

The olecranon fracture is then provisionally reduced and fixed, and length, angular alignment and radiocapitellar congruence is scrutinized fluoroscopically. It promotes stability of the radial head dislocation and allows very early mobilisation to prevent stiffness.

Type III is an ulnar metaphysis fracture with apex lateral. As is usually the case, in everyday practice, describing the fracture-dislocation is far more important than remembering the grade. This fracture should be treated with a closed reduction and splinted with the elbow flexed at approximately degrees in full supination for 6 weeks. Essentially all Monteggia fractures in adults will require operative intervention.

If this is not the case, residual deformity of the ulna is the typical culprit. If it does not, a dislocation should be suspected. The forearm is a vital structure in the human body that is essential for completing activities of daily living.

Synonyms or Alternate Spellings: What advice should I give to parents? In all patients, mechanism should be elicited, as this may inform the surgeon as to the involved force vectors and likely involved structures. Author Information Authors Neal P. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC.


He continued to have pain in the lateral aspect of his elbow, with an associated prominence anterolaterally. Reduction is always required and is urgent.

Monteggia fracture-dislocation | Radiology Reference Article |

Combined radius and long oblique ulnar fracture and reduced radial head dislocation. Pre-contoured olecranon plates allow for advantageous screw positioning in more proximal fracture patterns and locking technology for osteopenic bone. Strategies Trauma Limb Reconstr. HPI – pai and limitation of elbow since 2 years. Management of the ulna will vary based on the subtype of fracture: The most common fracture pattern involves an ulna with apex anterior deformity with a corresponding anteriorly dislocated radial head, consistent with a hyperextension mechanism.

How common are they and how do they occur?

Clinical Practice Guidelines : Monteggia fracture-dislocations – Emergency Department

Inquire about numbness, weakness, paresthesias, and radiating pain. Getting through the night.

The ulnar head supplements the triangular fibrocartilage complex TFCC at the wrist. This should be arranged by the consulting orthopaedic team after their reduction and stabilisation of the injury. Case 2 Case 2. What is the most appropriate treatment?