All Monteggia fracture-dislocations require an urgent orthopedic assessment. Reduction is always required. Delayed or missed diagnosis is the most frequent. Monteggia fractures account for approximately 1% to 2% of all forearm fractures. Distal forearm fractures are far more frequent than midshaft. Monteggia fracture-dislocations consist of a fracture of the ulnar shaft with concomitant dislocation of the radial head. The ulnar fracture is usually obvious.
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Symptoms pain, swelling, and deformity about the forearm and elbow Physical exam must palpate over radial head with all ulna fractures because spontaneous relocation of radial head is common must examine for plastic deformation of the ulna if there is a presumed isolated radial head dislocation ffacture radial head dislocations almost never occur in pediatric patients.
Pediatric Radial head dislocation? Pathophysiology The osseous forearm is composed of the radius and ulna bones.
Clinical Practice Guidelines : Monteggia fracture-dislocations – Emergency Department
Please login to add comment. In most circumstances, closed reduction should be attempted. To avoid proximal radioulnar joint PRUJ impingement, screw length should be carefully selected, and plates should be applied in the non-articular safe zone. Radial head dislocation and subtle ulnar bow. A type 1 coronoid fracture may be captured with a 2 non-absorbable suture through the adjacent capsule. An accompanying radial head fracture is common. A line drawn down the shaft of the radius should point to the center of the capitellum radiocapitellar line in both AP and lateral x-ray views to exclude joint dislocation.
Complications of ORIF surgery for Monteggia fractures can include non-union, malunion, nerve palsy and damage, muscle damage, arthritistendonitisinfectionstiffness and loss of range of motioncompartment syndromeaudible popping or snapping, deformity, and chronic pain associated with surgical hardware such as pins, screws, and plates.
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J Bone Joint Surg Am ; 92 3: Plastic deformation of the ulna. Management is determined by the characteristics of the ulna fracture. What radiological investigations should be ordered? The results of treatment of 36 pediatric Monteggia fractures. In adults, the most common presentation involves an axial force resulting in apex posterior deformity of the ulna and a posterior dislocation of the radial head. The Bado classification is a commonly used scheme that describes the direction of the radial head dislocation and the apex of the ulnar deformity.
Basilar skull fracture Blowout fracture Mandibular fracture Nasal fracture Le Fort fracture of skull Zygomaticomaxillary complex fracture Zygoma fracture.
Monteggia Fractures – Trauma – Orthobullets
In conjunction with the bimodal distribution, diaphyseal forearm fractures in young males are commonly due to high-energy trauma, for example, falls from height, sports injuries, motor vehicle accidents, and fractures in elderly females are due to low-energy trauma such as a ground level fall. Articles Cases Courses Quiz.
Clear Turn Off Turn On. How are they classified? Examination of the proximal and distal joint should be performed to identify concomitant injuries.
An approach to the subcutaneous border of the ulna between the extensor carpi ulnaris ECU and flexor carpi ulnaris FCU is made. Etiology Monteggia fractures most commonly result from a direct blow to the forearm with the elbow extended and forearm in hyperpronation.
Any radiographic series for forearm fracture must include quality AP and lateral views of the elbow, which are necessary and usually sufficient to identify radiocapitellar incongruity. Summary The Monteggia fracture involves a fracture of the ulna with an associated disruption of the radiocapitellar joint.
Operative management is crucial for the majority of adult Monteggia fractures.
In the rare setting in which a radiocapitellar pin is indicated, certain precautions should be taken. Since the radial head provides a degree of stability to the elbow, only very small and undisplaced fractures may be treated closed. Please vote below and help us build the most advanced adaptive learning platform in medicine The complexity of this topic is appropriate for?
Educational video describing the classification of monteggia fractures. Only one XRay is available from the initial injury, which is shown. Edit article Share article View revision history. Most incomplete ulna fractures were treated closed, while most complete ulna fractures were treated by operative fixation via either IM Kwire or plate fixation.
Because Monteggia fractures all involve disruption of the radiocapitellar joint, these injuries all require some form of intervention.
The fragments are reduced, and fixed with small countersunk or headless screws. Intra-operative fluoroscopic arthrogram may be the more expedient choice in this scenario. If there is a coronoid fragment that requires fixation, this can frequently be reduced under direct visualization through the olecranon fracture.
Evaluation and Management of Monteggia Fractures
An approach between the anconeus and the ECU is made, as described above. Stiffness may result from prolonged immobilization. Eur J Trauma Emerg Surg. History and physical exam begins any assessment. Management of the ulna will vary based on the subtype of fracture:.
The elbow joint is particularly susceptible to loss of motion. Notice that the ulna border is not straight shaded area. Under appropriate sedation, the ulnar shaft is manually reduced, which in most cases will lead to reduction of the radiocapitellar joint. Loading Stack – 0 images frscture. Bado classification of Monteggia fracture-dislocations. These will not uncommonly accompany posterior fracture configurations seen in adults.
Diaphyseal ulna and radial head fracture. About Blog Go ad-free. The two limbs may be passed through drill holes from the coronoid fracture bed to the dorsal side of rfacture ulna and tied at the end of the procedure.