Monteggia Fracture

Other Names

Monteggia Fractures

Background

Defined as a fracture of the proximal Ulna with a dislocation of the Radial Head
Originally described by Giovanni Battista Monteggia in 1814

Pathophysiology

Direct below to forearm with elbow extended and forearm pronated
Forces are transmitted leading to injury of the following structures:
- Ulna
- Radius and Radial Head
- Annular Ligament
- Quadrate Ligament
- Radiocapitellar Joint

Etiology

Falls from height^[1]
Sports
MVC
Low level trauma in elderly

Epidemiology

1-2% of all forearm fractures (need citation)
Bimodal: young males, elderly females

Risk Factors

Male > Female
Sports
- Football
- Wrestling
Osteoporosis
Menopause

Differential Diagnosis

Fractures
- Distal Radius Fracture
- Radius Ulna Fracture (Both Bone)
- Proximal Radius Fracture (Head, Neck)
- Isolated Ulna Fracture
- Monteggia Fracture
- Galeazzi Fracture
- Distal Ulna Fracture
- Essex Lopresti Fracture
Pediatric Specific Fractures
Dislocations & Instability
- Distal Radioulnar Joint Dislocation
- Proximal Radioulnar Joint Instability
Soft Tissue Trauma
- Acute Compartment Syndrome
Tendinopathies
- De Quervain's Tenosynovitis
- Intersection Syndrome
Neuropathies
- Radial Tunnel Syndrome
- Posterior Interosseus Nerve Syndrome
Pediatric Considerations
- Distal Radial Epiphysitis

Clinical Features

History
- Will have history of some type of trauma
- Patient typically reports pain, swelling
Physical Exam: Physical Examination Forearm
- Deformities, tenderness
- Perform a thorough neurovascular exam

Evaluation

Radiographs

Moteggia fracture. Note the midshaft ulna fracture and dislocated radial head. Soft tissue radiolucency suggests an open fracture

Need
Findings
- Radial head dislocation
- Displaced diaphyseal ulnar fracture

CT

Indications
- May be used for operative planning

MRI

Indications
- Evaluate other soft tissue injuries

Classification

Bado Classification

Type	Frequency	Description
Type I	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)^[2]
Type II	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	20%	Fracture of the ulnar metaphysis (distal to coronoid process) with lateral dislocation of the radial head
Type IV	5%	Fracture of the proximal or middle third of the ulna and radius with dislocation of the radial head in any direction

Management

Nonoperative

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

Operative

Intraoperative fluoroscopy of open reduction and internal fixation.

Most cases are considered surgical
Technique
- Open reduction, internal fixation

Return to Play

Variable
Surgical cases require at least 6 weeks
Discretion of surgeon

Complications

References

↑ 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.
↑ https://www.orthobullets.com/trauma/1024/monteggia-fractures

Created by:

John Kiel on 4 July 2019 07:11:33

Authors:

John Kiel

Last edited:

19 July 2021 23:02:01

Categories:

[1] 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.

[2] ttps://www.orthobullets.com/trauma/1024/monteggia-fractures

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