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Monteggia Fracture

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Other Names

  • Monteggia Fractures
  • Monteggia Fracture
  • Neglected Monteggia Fracture
  • Monteggia Lesion
  • Monteggia-equivalent Injuries
  • Monteggia Fracture Dislocation
  • Monteggia-like-lesion
  • Monteggia-lesion


  • This page refers to the eponymous Monteggia Fracture


  • Originally described by Italian Surgeon Giovanni Battista Monteggia in 1814[1]
  • Eponymously named as the Monteggia fracture by Perrin in 1909[2]
  • In 1958, Uruguayan surgeon Bado elaborated on the pathomechanics and management[3]


  • Rare, account for 1-5% of all forearm fractures[4]
  • Bimodal: young males, elderly females
  • More common in children between ages 4 and 10 (need citation)


Illustratin of Monteggia fracture (Bado Type II)[5]


  • Defined as a fracture of the proximal Ulna associated with a dislocation of the Radial Head
  • Typically occurs due to a direct below to forearm with elbow extended and forearm pronated
  • The diagnosis can be made with forearm and elbow radiographs
  • An unstable fracture pattern requiring emergent orthopedic consultation and surgical correction



  • Falls from height[6]
  • Sports
  • MVC
  • Low level trauma in elderly
  • Direct blow to the forearm with elbow extended, forearm pronated

Modern Definition

  • Monteggia-like lesions include multiple injury patterns of the proximal ulna and radial head
  • Giannicola expanded on the classical pattern, identifying additional injuries including[7]
    • Ulno-humeral dislocation
    • Proximal radio-ulnar dislocation
    • Radial fracture
    • Distal radio-ulnar joint lesion
  • For this reason, definition of injury patterns is inconsistent throughout the literature
    • This makes it difficult to compare different treatment strategies

Associated Injuries

Risk Factors

  • Male > Female
  • Sports
    • Football
    • Wrestling
  • Osteoporosis
  • Menopause

Differential Diagnosis

Differential Diagnosis Forearm Pain

Clinical Features


  • Will have history of some type of trauma
  • Patient typically reports pain, swelling
  • Ask about any neurological symptoms

Physical Exam: Physical Examination Forearm

  • Deformities, tenderness at the fracture site
    • Radiocapitellar dislocation may not be obvious
  • Evaluate for any breaks in the skin/ skin integrity
  • Carefully evaluate the elbow and wrist joints
    • Elbow joint ROM may be diminished due to dislocation
  • Perform a thorough neurovascular exam, especially of the radial and median nerves
    • Posterior Interosseous Nerve (radial deviation of hand with extended wrist)
  • Palpate all compartments to confirm they are soft


Moteggia fracture. Note the midshaft ulna fracture and dislocated radial head. Soft tissue radiolucency suggests an open fracture
In this pediatric patient, a displaced and overlapped fracture of the ulnar shaft is present. Additionally the radial head is dislocated anteriorly. [8]



  • Indications
    • May be used for operative planning
    • Better evaluates the coronoid, olecranon, radial head


  • Indications
    • Evaluate other soft tissue injuries


Illustrations of the Bado classification of Monteggia fracture-dislocations.[9]

Bado Classification

  • Type 1
    • Frequency: 60%
    • Fracture of the proximal or middle third of the ulna with anterior dislocation of the radial head (most common in children and young adults)
  • Type II
    • Frequency: 15%
    • Fracture of the proximal or middle third of the ulna with posterior dislocation of the radial head (70 to 80% of adult Monteggia fractures)
  • Type III
    • Frequency: 20%
    • Fracture of the ulnar metaphysis (distal to coronoid process) with lateral dislocation of the radial head
  • Type IV
    • Frequency: 5%
    • Fracture of the proximal or middle third of the ulna and radius with dislocation of the radial head in any direction

Jupiter Classification for Type II Monteggia Fracture-Dislocation

  • Type IIA: Fracture at Coronoid level
  • Type IIB: Fracture at Metaphyseal-diaphyseal junction
  • Type IIC: Fracture at Distal to coronoid
  • Type IID: Fracture at Fracture extending to distal half of ulna


Intraoperative fluoroscopy of open reduction and internal fixation.


  • Generally a surgical injury, however nonoperative approach may be attempted in appropriate patient
  • Recommend making decision in collaboration with orthopedic surgeon
  • Can attempt closed reduction in minimally displaced ulna fractures
  • This is more successful in children
  • Cast: Long Arm Cast with wrist in supination


  • Indications
    • Most cases are considered surgical
    • All adults
    • Unstable pediatric fractures
  • Technique
    • Open reduction, internal fixation

Pediatric Considerations

  • In children with a stable radiocapitellar joint, closed reduction can be definitive

Rehab and Return to Play


  • Needs to be updated

Return to Play/Work

  • Variable
  • Surgical cases require at least 6 weeks
  • Discretion of surgeon

Prognosis and Complications

Neglected Monteggia fracture. (a) Pre-operative clinical picture with cubital valgus of 45 degree and (b) Pre-operative radiograph with radial head dislocated anteriorly.[10]


  • Children tend to have better outcomes than adults
  • Delayed diagnosis/ proper treatment
    • Leads to deformities and dysfunction


See Also



  1. Monteggia GB. Lussazioni delle ossa delle estremita superiori. In: Monteggia GB, ed. Instituzioni Chirurgiches. 2nd ed. Vol. 5. Milan: Maspero; 1814:131e133.
  2. Perrin J. Les fractures du cubitus accompagnees de luxation de l’extremite superieur du radius. In: Perrin J, ed. These de Paris. Paris: G Steinheil; 1909.
  3. . Bado JL. La lesion de Monteggia. Buenos Aires: Inter-Medica Sarandi; 1958:328
  4. Josten C, Freitag S (2009) Monteggia and monteggia-like-lesions: classification, indication, and techniques in operative treatment. Eur J Trauma Emerg Surg 35(3):296–304.
  5. Image courtesy of https://www.rch.org.au/
  6. Calderazzi F, Galavotti C, Nosenzo A, Menozzi M, Ceccarelli F. How to approach Monteggia-like lesions in adults: A review. Ann Med Surg (Lond). 2018 Nov;35:108-116.
  7. Giannicola G, Sacchetti FM, Greco A, Cinotti G, Postacchini F (2010) Management of complex elbow instability. Musculoskelet Surg 94(Suppl 1):S25-36
  8. Case courtesy of Frank Gaillard, Radiopaedia.org, rID: 8012
  9. Lopez, Belen, Luis Caro, and Antonio F. Pardinas. "Type I Monteggia fracture-dislocation in a monk from a 17th–18th century necropolis of Valladolid (Spain)." Anthropological Science 119.1 (2011): 39-47.
  10. Gooi, S. G., et al. "Ulnar osteotomy with 2-pin unilateral gradual distraction for treatment of chronic Monteggia fracture: a case report." Malaysian orthopaedic journal 11.1 (2017): 79.
Created by:
John Kiel on 4 July 2019 07:11:33
Last edited:
6 June 2024 20:40:05
Trauma | Osteology | Forearm | Upper Extremity | Fractures | Acute