The ulna fracture is usually clinically and radiographically apparent. - note: that patients whose operative treatment is delayed may be found to have a progressive PIN palsy from Bado type III lesion with lateral displacement of the radial head. The mean Broberg and Morrey score increased from 89 points to 94 points, and the median Disabilities of the Arm, Shoulder, and Hand (DASH)score was 7 points at long-term follow-up. - frx of ulna just distal to coronoid process w/ lateral dislocation of radial head; - Type IV (5%) The radial head should point towards the capitellum on all radiographs of the elbow. Leonidou A, Pagkalos J, Lepetsos P, Antonis K, Flieger I, Tsiridis E, et al. constantpressure exerted by the dislocated radial head; [QxMD MEDLINE Link]. Vol 2: 520. J Pediatr Orthop 2015; 35 (2) 115-120. - spontaneous recovery is usual & exploration is not indicated; - Radiographs: Waters PM. - radiohumeral ankylosis If the elbow is flexed, the chance of a type II or III lesion is greater. [7] Interestingly, he described this injury pattern in the pre-Roentgen era solely on the basis of the history of injury and the physical examination findings. Bennett fracture is the most common fracture involving the base of the thumb. Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). - PIN palsy is most common in type I frx and may occur in a delayed fashion if theradial Complex Monteggia Fractures in the Adult Cohort: Injury and Management. It is named after Giovanni Battista Monteggia. - associated nerve injury: - then elbow is gently flexed to > 90 deg to relax biceps; 91 (6):1394-404. - attempt to palpate radial head (ant, post, or lateral); Successful Strategies for Managing Monteggia Injuries. Vol 1: Nakamura K, Hirachi K, Uchiyama S, Takahara M, Minami A, Imaeda T, et al. 2023 Lineage Medical, Inc. All rights reserved. - keep elbow flexed ( > 90 deg), to relax biceps, so that full supination can be avoided w/o losing reduction; - Non Operative Treatment: 36 (2):65-73. Unrecognized dislocations may result from reduction of the dislocated radius prior to presentation. Trauma10531822MonteggiaFracturesAuthor:Tracy JonesIntroductionInjury defined asproximal 1/3 ulnar fracture with associated radial head dislocation/instabilityEpidemiologyrare in adultsmore common in childrenwith peak incidence between 4 and 10 years of agedifferent treatment protocol for childrenAssociated injuriesmay be part of complex injury - this is esp true on the lateral projection; Pronation injuries of the forearm, with special reference to theanterior Monteggia fracture. Some injuries associated with radiocapitellar dislocation (such as the transolecranon fracture-dislocation of the elbow) are mislabeled as Monteggia lesions, when in fact the PRUJ remains intact. (0/1), Level 5 After undergoing closed reduction, the radiocapitellar joint is noted to remain non-concentric. These ligaments stretch or rupture during radial head dislocation. PENROSE JH. "A Monteggia fracture with apex anterior ulnar shaft fracture is associated with an anterior radial head dislocation. The olecranon, midshaft, and distal shaft may be involved. 2016 Jun. - ulnar frx is treated w/ compression plate (esp in proximal third) The posterior interosseous nerve travels around the neck of the radius and dives under the supinator as it courses into the forearm. Philadelphia: JB Lippincott; 1991. Ulnar fracture with late radial head dislocation: delayed Monteggia fracture. [QxMD MEDLINE Link]. This is the most common type of Monteggia fracture. - type II lesions with posterior dislocations should be maintained in about 70 deg. Persistent posterior interosseous nerve palsy associated with a chronic type I Monteggia fracture-dislocation in a child: a case report and review of the literature. [QxMD MEDLINE Link]. Monteggia Fractures in Pediatric and Adult Populations, Clifford R. Wheeless, III, M.D. Fractures in Adults. The close proximity of these nerves may lead to injuries when a Monteggia fracture occurs. Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children. The Monteggia fracture with posterior dislocation of the radial head. [QxMD MEDLINE Link]. This article describes the diagnosis, treatment, and potential pitfalls encountered in the treatment of Monteggia fractures. Orthop Clin North Am. [QxMD MEDLINE Link]. Twenty-six patients (68 percent) who had a Bado type-II fracture had an associated fracture of the radial head; ten of these patients also had a fracture of the coronoid process as a single large fragment. A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. (OBQ09.264) 2022 Jul 22. Medscape Education. [QxMD MEDLINE Link]. Waters PM, Bae DS, eds. - line drawn thru radial shaft and radial head should align w/ capitellum in any position if the radial head is in normal position Hand (N Y). Proximal radius dislocations in skeletally immature teenagers and children occur in the setting of a spectrum of ulnar injuries that often do not follow classic adult patterns. The ulna was fixed with a tension band-wire construct supplemented with screws in three patients (all of whom had a Bado type-II fracture). The fracture of the radial head was treated with either complete or partial excision of the fragments in twelve patients (with replacement with a silicone prosthesis in two), open reduction and internal fixation in ten patients, and no intervention in four patients. The Orthobullets Podcast In this episode, we review the high-yield topic of Monteggia Fractures from the Trauma section. Compartment Syndrome in Operatively Managed Pediatric Monteggia Fractures and Equivalents. In some cases, a direct blow to the forearm can produce similar injuries. Are you sure you want to trigger topic in your Anconeus AI algorithm? Whenever a fracture of a long bone is noted, the joints above and below should be evaluated with radiographs in orthogonal planes (planes at 90 angles to each other). - spontaneous recovery is usual & exploration is not indicated; [QxMD MEDLINE Link]. Orthopaedic Specialists of North Carolina. Epub 2012 Oct 10. (1/8), Level 3 - achieved w/ forarm in full supination, & longitudinal traction; 2020 Mar. 1949 Nov. 31B (4):578-88, illust. Floriano Putigna, DO, FAAEM Staff Physician, Florida Emergency Physicians, Inc, and Florida Hospital Orthopedics. A Monteggia fracture-dislocation, or proximal ulnar fracture with associated radial head dislocation, is a complex injury of the forearm and elbow that can destabilize the elbow leading to poor functional outcomes. 1967; 50:71-86. This website also contains material copyrighted by 3rd parties. Wang C, Su Y. [Full Text]. anterior dislocation of radial head; Chin J Traumatol. [QxMD MEDLINE Link]. An Alternative to the Traditional Radiocapitellar Line for Pediatric Forearm Radiograph Assessment in Monteggia Fracture. of flexion for 6 weeks; - Delayed Dx: The distal ulna and radius also articulate at the DRUJ. The posterior (Bado type-II) fracture is the most common type of Monteggia fracture in adults. On examination, the affected arm is swollen and tender around his elbow. Rang's children's fractures. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. (1/1), Level 4 - posterior or posterolateral dislocation of radial head (or frx); - posterior interosseous nerve may be wrapped around neck of radius, preventing reduction; Bado initially described and classified these injuries. The Monteggia lesion. [Full Text]. 7th ed. Forearm fractures in children. Monteggia described a fracture of the proximal third of the ulna with anterior dislocation of the radial head from both the proximal radioulnar and radiocapitellar joints. 40 (3):e216-e221. The radius and ulna are closely invested by the interosseous membrane, which accounts for the increased risk of displacement or injury to the radius when the ulna fractures. (0/8), Level 1 It is the character of the ulnar fracture, rather than the direction of radial head dislocation, that is useful in determining the optimal treatment of Monteggia fractures in both children and adults. J Bone Joint Surg Br. The Monteggia lesion is most precisely characterized as a forearm fracture in association with dislocation of the PRUJ. Late reconstruction of chronic Monteggia lesions in children can be complicated and unpredictable. and radial deviation of head; - Complications: [QxMD MEDLINE Link]. Monteggia fractures and their variants are often misdiagnosed, however, because of the numerous atypical presentations of this injury in children. (OBQ10.240) 2018 Feb. 104 (1S):S113-S120. Monteggia fracture-dislocation in children. Wong JC, Getz CL, Abboud JA. plastic deformation of the ulna without obvious fracture, pain, swelling, and deformity about the forearm and elbow, isolated radial head dislocations almost never occur in pediatric patients, a line down the radial shaft should pass through the center of the capitellar ossification center, radial head is stable following reduction, radial head will reduce spontaneously with reduction of the ulna and restoration of ulnar length, for Type I, elbow flexion is the main reduction maneuver, if reduction of radiocapitellar joint is unsuccessful, annular ligament is most common block to reduction, radial head is not stable following reduction, ulnar length is not stable (unable to maintain ulnar length), older patients 10y if closed reduction is not stable, symptomatic individuals (pain, loss of forearm motion, progressive valgus deformity) who had delayed treatment or missed diagnosis, open reduction of radial head through a lateral approach if needed in chronic (>2-3 weeks old) Monteggia fractures where radial head still retains concave structure, annular ligament reconstruction almost never required for acute fractures, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). The records concerning ten consecutive years of experience with Monteggia fractures in adult patients at a level-one trauma center were retrospectively reviewed. Treatment may be closed reduction and casting for length stable ulna fractures with a stable radiocapitellarjoint. In 17 of the 22 patients, the radial head remained in a completely reduced position, and it was subluxated in five patients. 1998 Dec;80(12):1733-44. 2023 Lineage Medical, Inc. All rights reserved. Separate radiographs should be taken of the elbow. Philadelphia: Lippincott Williams &Wilkins; 2010: 446-74. A review of the complications. Loss of alignment after surgical treatment of posterior Monteggia fractures: salvage with dorsal contoured plating. there may be slow and progressive shortening and angulation; J Bone Joint Surg Am. J Bone Joint Surg Am. As multiple variants of Monteggia fractures exist, it is most accurately described as a forearm fracture with dislocation of the proximal radioulnar joint.4 Subtle bowing of the ulna shaft with an asssociated radiocapitellar dislocation may be missed by the inexperienced clinician who is looking for a forearm fracture and therefore