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I – Extension type (60%): Ulna shaft angulates anteriorly (extends) Radial head dislocates anteriorly. There are four classifications of a Monteggia fracture. The surgery is done by an orthopedic surgeon, who is a surgical specialist that has received special training working with injuries to the bone, especially this type of fracture. The nerve injury is usually treated expectantly. Put the ice pack into a plastic bag and wrap in a towel before you put it on the cast so the cast will not get wet. 7 If the Monteggia fracture is severe you may need to have surgery. The health information provided on this web site is for educational purposes only and is not to be used as a substitute for medical advice, diagnosis or treatment. In particular the ramus profundus of the radial nerve is exposed to injury but other nerves may also be involved. This can be around the radial head or the annular ligament. If an ulna fracture is present, always look for a radial head dislocation.All Monteggia fracture-dislocations require an urgent orthopedic assessment. The prompt diagnosis and treatment of these acute injuries result in excellent outcomes. Reduction is always required. What is the usual ED management for this fracture? Complications clearly vary with fracture site and nature and with quality of surgery but many also vary with patient attributes such as: Age. Your ulna is a bone in your forearm that is broader near your elbow and tapers as it approaches your wrist. Reduction is always required. It is named after Giovanni Battista Monteggia. They are referred to as Bado classifications. The radial nerve is the most commonly injured nerve (10-20%). Monteggia fracture-dislocations can be easily missed on x-ray. Most complications arise from missed or delayed diagnoses of Monteggia fracture-dislocations. The ulnar fracture is usually obvious, whereas the radial head dislocation can be overlooked, with potentially serious functional and medico-legal ramifications. Fracture upper third of ulna with dislocation head of the radius . Rehabilitation is necessary in order for your muscles to become stronger. History of the Monteggia fracture-dislocation 1812 – Giovanni Battista Monteggia (1762 – 1815) recorded two observations of a traumatic lesion distinguished by a fracture of the proximal third of the ulna and an anterior dislocation of the proximal radius in ‘ Lussazioni delle ossa delle estremita superiori.’ In adults, the healing is slower and results usually not as good. Figure 3: Nine year old girl with type III Monteggia fracture-dislocation. 50 Flemington Road Parkville Victoria 3052 Australia, Site Map | Copyright | Terms and Conditions, A great children's hospital, leading the way, Monteggia fracture-dislocations - Fracture clinics. It is concluded that Monteggia lesions … There is an ulna midshaft fracture. J Bone Joint Surg Am 2010; 92(3): 756-64. Beaty JH, Kasser JR (Eds). Treatment after delayed diagnosis is much more complex and the outcomes are much less satisfactory. There must also be a true AP and lateral view of the elbow (not just a forearm view) to assess the radiocapitellar joint. Delayed diagnosis is the most frequent complication. Smoking status. Achieving good results when treating these injuries depends on timely identification, understanding of the pathoanatomy, and appreciating the differences … Complications of Monteggia fractures often result from nonanatomic or loss of fixation of the ulna fracture, leading to recurrent dislocation of the radial head. When is reduction (non-operative and operative) required? Failure to recognize a monteggia fracture can have severe consequences. The patients were managed by a number of surgeons, and no standard treatment or rehabilitation protocols were used. Pictures : How Monteggia Fracture Looks like? In Rockwood and Wilkins' Fractures in Children, 7th Ed. 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. However if the ulna has a greenstick fracture or 'plastic bowing', deformity is mild and the fracture can be easily missed. The posterior border of the ulna should also be assessed. Many times the Monteggia fracture will have to be treated using surgery. Other indications for prompt consultation include: The arm should be splinted and the nearest on call orthopaedic service be consulted. After surgery there could be complications or long range problems such as: If the fracture does not heal correctly you could have one arm that is shorter than the other arm. If it is not straight, it indicates a plastic deformation injury. Nutritional staus. Monteggia Fracture-Dislocations Acute Complications Failure to make the diagnosis is the most common, acute complication of a Monteggia fracture-dislocation. Originally described by Giovanni Battista Monteggia in 1814, the Monteggia fracture is a fracture of the proximal ulna associated with a dislocation of the radial head. The line drawn down the shaft of the radius does not pass through the centre of the capitellum (asterix). The immediate postoperative radiographs showed inaccurate reduction of the proximal ulnar fracture, resulting in abnormal articular congruence of the elbow joint. Late reconstruction is difficult and often results in … A big risk with an open fracture, which means that your skin has been damaged during the injury or the bone has broken through your skin, is necrosis. It is rare for an adult to have a Monteggia fracture but is most common in children between the ages of four and ten. Approximately 90% of children with Monteggia fracture-dislocations have good to excellent results. A radial head dislocation is evident as shown by the radiocapitellar line. To identify this injury, it is essential to have x-rays that include both the elbow and forearm.

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