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Monteggia Fracture
From WikiSM
Contents
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
- Pediatric Specific Fractures
- Dislocations & Instability
- Soft Tissue Trauma
- Tendinopathies
- Neuropathies
- Pediatric Considerations
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
- 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
- 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
See Also
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