![]() Type I Monteggia fracture-dislocation (with ulna mid shaft fracture)įigure 1: Ten year old girl with type I Monteggia fracture-dislocation. Notice that the ulna border is not straight (shaded area). Normal ulna with straight border (red line) If it is not straight, it indicates a plastic deformation injury. The posterior border of the ulna should also be assessed. TIP: 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. To identify this injury, it is essential to have x-rays that include both the elbow and forearm. If an ulna fracture is present, always look for a radial head dislocation. Monteggia fracture-dislocations can be easily missed on x-ray. There must also be a true AP and lateral view of the elbow (not just a forearm view) to assess the radiocapitellar joint. ![]() What radiological investigations should be ordered?Īnteroposterior (AP) and lateral x-rays of the forearm that include the wrist and elbow should be ordered. However if the ulna has a greenstick fracture or 'plastic bowing', deformity is mild and the fracture can be easily missed. The forearm may look deformed if the ulna fracture is displaced. It will be painful to move the elbow in any plane. There may be diffuse swelling around the elbow, but the degree is variable. Type I fractures are usually a result of a fall on an outstretched hand with hyperpronation or hyperextension of the forearm. ![]() These fractures are a less common injury compared to forearm fractures. How common are they and how do they occur? Lateral dislocation of the radial head with fracture of the ulna metaphysisĪnterior dislocation of the radial head with fracture of the shaft (diaphysis) of the ulna and radiusģ. Posterior dislocation of the radial head with fracture of the ulna shaft (diaphysis) or metaphysis Table 1: Bado classification of Monteggia fracture-dislocations.Īnterior dislocation of the radial head with fracture of the ulna shaft (diaphysis) ![]() The Bado classification system (Table 1) describes four types. How are they classified?Ī Monteggia fracture-dislocation refers to dislocation of the radial head (proximal radioulnar joint) with fracture of the ulna. Delayed or missed diagnosis is the most frequent complication. If an ulna fracture is present, always look for a radial head dislocation.Īll Monteggia fracture-dislocations require an urgent orthopedic assessment. What are the potential complications associated with this injury?.What is the usual ED management for this fracture?.Do I need to refer to orthopaedics now?.When is reduction (non-operative and operative) required?.What radiological investigations should be ordered?.How common are they and how do they occur?.Please see our publications on radius fractures.Monteggia fracture-dislocations - Fracture clinics The HSS Orthopedic Trauma Service has conducted many studies. Lateral radiograph of the left-sided Monteggia fracture-dislocation respectively.Īnteroposterior and lateral radiographs at 12 months illustrating healed Monteggiaįracture-dislocations in excellent alignment.Ĭlinical pictures at 12 months demonstrating excellent range of motion. Kloen P, Rubel IF, Farley TD, Weiland AJ, Helfet DL: "Bilateral Monteggia fractures."Īnteroposterior, and lateral injury radiographs of the right-sided Monteggia fracture-dislocation and She most recently returned for routine follow-up at 1 year following fracture surgery with excellent radiographic and clinical results including healed Monteggia fractures, complete resolution of pain, excellent range of motion, and she has returned to all activities of daily living. Weiland with placement of plates, screws a single cerclage wire (left-side) and interfragmentary lag screws. Weiland, MD at the Orthopedic Trauma Service at Hospital for Special Surgery. Radiographs revealed bilateral (right- and left-sided) Monteggia fractures with posterior dislocations of both radial heads (Bado type-II injuries). Case Example Bilateral Monteggia Fracture DislocationsĪ previously healthy female, 53 years of age, fell when she tripped while carrying a laundry basket down steps landing on the dorsal aspects of her flexed elbows, and had immediate pain in both upper extremities.
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