Monteggia fracture-dislocations consist of a fracture of the ulnar shaft with concomitant dislocation of the radial head. The ulnar fracture is usually obvious. Monteggia appreciated that the ulna fracture was linked to the radial head the term Monteggia fracture-dislocation in in his publication Thesis de Paris. Monteggia described a fracture of the proximal third of the ulna with . Reynders P, De Groote W, Rondia J, Govaerts K, Stoffelen D, Broos PL.
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Monteggia fracture-dislocations – Fracture clinics. Monteggia fracture-dislocations can be easily missed on x-ray.
If an ulna fracture is present, always look for a radial head dislocation.
Monteggia fracture-dislocations: A Historical Review
All Monteggia fracture-dislocations require an urgent orthopedic assessment. Reduction is always required.
Delayed or missed diagnosis is the most frequent complication. A Monteggia fracture-dislocation refers to dislocation of the radial head proximal monnteggia joint with fracture of the ulna.
The Bado classification system Table 1 describes four types. Posterior dislocation of the radial head with fracture of the ulna shaft diaphysis or metaphysis.
Anterior dislocation of the radial head with fracture of the shaft diaphysis of the ulna and radius. These fractures are a less common injury compared to forearm fractures. montegvia
The peak incidence is years of age. Type I fractures are usually a result of a fall on an outstretched hand with hyperpronation or hyperextension of the forearm.
There may be diffuse swelling around the elbow, but the degree is variable.
It will be painful to move the elbow in any plane. The forearm may look deformed if the ulna fracture is displaced. However if the ulna has a greenstick fracture or ‘plastic bowing’, deformity is mild and the fracture can be easily missed. Anteroposterior AP and lateral x-rays of the forearm that include the wrist and elbow should be ordered. There must also be a true AP and lateral view of the elbow not just a forearm view to assess the radiocapitellar joint.
To identify this injury, it is essential to have x-rays that include both the elbow and forearm.
A line drawn down the shaft of the radius should point to the center mlnteggia the capitellum radiocapitellar line in both AP and lateral x-ray views to exclude joint dislocation. The posterior border of the ulna should also be assessed. It should be straight, not bowed. If it is not straight, it indicates a plastic deformation injury.
Plastic deformation of the ulna.
Notice that the ulna border is not straight shaded area. Ten year old girl with type I Monteggia fracture-dislocation. A radial head dislocation is evident as shown by the radiocapitellar line white line. The line drawn down the shaft of the radius does not pass through the monteeggia of the capitellum asterix. There is an ulna midshaft fracture. Type I Monteggia fracture-dislocation. A radial head dislocation is evident as shown by the radiocapitellar line.
The line drawn down the shaft of the radius does not pass through the centre of the capitellum. There is plastic deformation of the ulna. Lateral x-ray of Monteggia type IV fracture in a six year old boy, as evident by dislocation of the radial head with fractures of both the shafts of the radius and ulna. This should be arranged by the consulting orthopaedic team after their reduction and stabilisation of the injury.
Follow-up in fracture clinic needs to be in 7 days with an mmonteggia. If identified early, these injuries will do well. Treatment after delayed diagnosis is much more complex and the outcomes fz much less satisfactory. This is why litigation is common. See fracture clinics for other potential complications. Pediatric fractures of the forearm. Clin Ortho Relat Res ; Scherl S, Schmidt A.
Getting through the night. Montegfia Bone Joint Surg Am ; 92 3: Monteggia fracture-dislocation in children. The Royal Children’s Hospital Melbourne. Monteggia montehgia – Emergency Department. How common are they and how do they occur?
What do they look like – clinically? What radiological investigations should be ordered?
What do they look like on x-ray? When is reduction non-operative and operative required? Do I need to refer to orthopaedics now? What montegbia the usual ED management for this fracture? What follow-up is required?
Monteggia fracture-dislocations – Emergency Department
What advice should I give to parents? What are the potential complications associated with this injury? Summary Monteggia fracture-dislocations can be easily missed on x-ray. How are they classified? Bado classification of Monteggia fracture-dislocations.
Nine year old girl with type III Monteggia fracture-dislocation. Type IV Monteggia fracture-dislocation Figure 4: Reduction is always required and is urgent. This is usually performed in theatre under a general anaesthetic. All Monteggia fracture-dislocations require an urgent orthopaedic assessment.
Other indications for prompt consultation include: The arm should be splinted and the nearest on call orthopaedic service be consulted. Delayed diagnosis is the most frequent complication. The posterior interosseous nerve can also be injured due to its proximity to the radial head. The injury is usually a neuropraxia. Peripheral nerve examination needs to be documented.
Monteggia fracture-dislocations: A Historical Review
The nerve injury is usually treated expectantly. To provide feedback, please email rch. Anterior dislocation of the radial head with fracture of the ulna shaft diaphysis.
Lateral dislocation of the radial head with fracture of the ulna metaphysis. Normal ulna with straight border red line.