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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Examination minteggia the proximal and distal joint should be performed to identify concomitant injuries. Adult anterior and lateral fractures The ulna is approached first through a midline posterior incision extended along its subcutaneous border.

The use of MRI and ultrasound is not usually indicated, though these modalities may be used when fracture of a non-ossified radial head is suspected in a child less than 4 years of age. Plate removal should be considered in the pediatric population once fracture healing is mature. In the pediatric patient, history of preceding injury, or pre-injury lack of full range of motion will alert the surgeon to a chronic or previously under-treated Monteggia variant, or to a history of congenital radial head dislocation.

Monteggia fracture-dislocation in children.

Comminuted or long oblique ulna fractures are fixed by ORIF using plates and screws. You can also scroll through stacks with your tracture wheel or the keyboard arrow keys. Formal physiotherapy is rarely needed in the pediatric population, mmonteggia elbow range of motion may take several months for complete recovery. This page was last edited on 27 Octoberat The Bado classification is a commonly montegga scheme that describes the direction of the radial head dislocation and the apex of the ulnar deformity.


Treatment after delayed diagnosis is much more complex and the outcomes are much less satisfactory. Monteggia fractures remain difficult to diagnose clinically, and debilitating complications can occur if proper management is not initiated.

Care should be taken to stay anterior to and preserve the lateral collateral ligament.

History and Physical Patients with diaphyseal forearm fractures usually complain of pain at the site of injury. Reduction should be maintained through flexion, extension, pronation and supination. The ulna is approached montdggia through a midline posterior incision extended along its subcutaneous border. In adults, the healing is slower and results usually not as good. This indicates a need for operative correction.

Forty-eight adults patients with Monteggia variants were followed for at least 2 years. Patients with high demand activity athletes and manual workers may require up to 12 to 16 weeks of rehab. Post—operative Rehabilitation Children should be placed in a well-molded long-arm cast after open or closed reduction. The threshold for replacement instead of reconstruction should be even lower in the setting of an adult Monteggia fracture dislocation than in an isolated radial head or neck fracture because of the necessity of an monteeggia radial column for stability through early range of motion Figure 5Figure 6Rfacture 7.

For pre-operative planning computed tomography CT may be utilized to evaluate for non-union and magnetic resonance imaging MRI can help assess for TFCC tears and interosseous membrane disruption. In children, most of these injuries can have excellent outcomes, provided there is accurate and timely diagnosis, and that radiocapitellar reduction is maintained. Getting through the night. Educational video describing the classification of monteggia fractures. As is usually the case, in everyday practice, describing the fracture-dislocation is far more important than remembering the grade.


The ulna fracture is addressed first. Pathophysiology The osseous forearm is composed of the radius and ulna bones.

To quiz yourself on this article, log in to see multiple choice questions. Monteggia injuries are easily missed, particularly the radial head dislocation, frcature the ulnar shaft fracture can be distracting.

Evaluation and Management of Monteggia Fractures – Cancer Therapy Advisor

It should be straight, not bowed. All four types of Monteggia fracture-dislocations see Bado classification are treated with open reduction and internal fixation. Clear Turn Off Turn On. Lateral x-ray of Monteggia type IV fracture in a six year old boy, as evident by dislocation of the radial head with fractures of both the shafts of the radius and ulna. Radiographs recommended view AP and Lateral of elbow, wrist, and forearm CT scan helpful in fractures involving coronoid, olecranon, and radial head.

If an ulna fracture is present, always look for a radial head dislocation.

Provided that films of adequate quality are obtained, the ulnar fracture is usually obvious fractude the radial head dislocation should be readily identifiable. Please review our privacy policy.

Monteggia fractures in adults.

Monteggia Fracture – Pediatric

Operative management is crucial for the majority of adult Monteggia fractures. Posterior dislocation of the radial head with fracture of the ulna shaft diaphysis or metaphysis. Residual radiocapitellar instability is almost always a result of residual ulnar monteggia.