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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Evaluation and Management of Monteggia Fractures
Inquire about numbness, weakness, paresthesias, and radiating pain. The ulnohumeral, radiocapitellar, proximal radio-ulnar articulations must all be restored, along with supporting ligamentous structures.
Short, oblique fractures should fraxture stabilized with elastic intramedullary titanium nail fixation. Definitive fixation with an appropriate plate is then completed.
However, there is a wide range of potentially associated pathology that must be identified, treated, and recognized that has monnteggia implications. Srp Arh Celok Lek. Monteggia fractures remain difficult to diagnose clinically, and debilitating complications can montwggia if proper management is not initiated. The boy’s parents report that his arm never looked right after the injury. Delayed diagnosis is the most frequent complication. Radiographs should also include the wrist, as there may be a concomitant fracture of the distal radius, which indicates higher energy and should raise suspicion for compartment syndrome, or disruption of the interosseous membrane and longitudinal forearm instability.
J Bone Joint Surg Am ; 92 3: The Bado classification is a commonly used scheme that describes the direction of the radial head dislocation and the apex of the ulnar deformity. Please vote below and help us build the most advanced adaptive learning platform in medicine.
Monteggia fracture – Wikipedia
Support Radiopaedia and see fewer ads. Contributed by Neal Johnson, MD. An upper arm tourniquet should be placed, and the arm should be prepped and draped as high above the elbow as possible. Combined open bipolar Monteggia and Galeazzi fracture: A Problem for Gene Editing in Cancer? Successful Strategies for Managing Monteggia Injuries.
The patient presents with his parents with complaints of left elbow pain with movement and inability to participate in sports. For these reasons, it is common practice to forgo open reduction of the radial head or formally addressing the annular ligament provided radiographic alignment is perfect.
Affilations 1 Univeristy of Tennessee Nashville. The surgeon should be prepared to perform appropriate repairs and replacements. They were advised to wait two years which did not yield significant improvement, so they finally sought treatment elsewhere.
Surgical Technique Patient set—up In adults, operative treatment is usually performed under regional blockade and general anesthesia.
Patient’s fractire think he fell on an outstretched arm. In children, size-appropriate 2. Management is determined by the characteristics of the ulna fracture. 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.
Open reduction of radial head dislocation with casting in supination and flexion. Pediatric fractures of the forearm. To avoid proximal radioulnar joint PRUJ impingement, screw gracture should be carefully selected, and plates should be applied in the non-articular safe zone. Radiocapitellar pins should be avoided whenever possible.
This page was last edited on 27 Octoberat Pearls and Other Issues Monteggia injuries are easily missed, particularly the radial head dislocation, as the ulnar shaft fracture can be distracting.