Monteggia Fracture

synonyms:

Monteggia Fx ICD-9

• 813.03(closed Monteggia's fracture)
• 813.13(open Monteggia's fracture)

Monteggia Fx Etiology / Epidemiology / Natural History

• Definition: fracture near the head of the ulna with associated dislocation of the radial head.
• Accounts for less than 5 % of all forearm fractures.
• More common in children.
• Adult injuries are typically high energy, fall from heights or MVA.

Monteggia Fx Anatomy

• See also Elbow anatomy.

Monteggia Fx Clinical Evaluation

• Pain and swelling in the elbow and ulnar border of the forearm. ROM limited by pain.
• Evaluate soft-tissue envelope.
• Document NV exam.
• Evaluate for compartment syndrome.
• Document wrist evaluation.

Monteggia Fx Xray / Diagnositc Tests

• A/P and Lateral forearm views, A/P, lateral elbow films, P/A and lateral wrist views demonstrate radial head dislocation and ulnar shaft fracture.

Monteggia Fx Classification / Treatment

• Bado
  Type I:  Fracture of the ulnar diaphysis at any level with anterior angulation at the fracture site and an associated anterior dislocation of the radial head.
  Type II:  Fracture of the ulnar diaphysis with posterior angulation at the fracture site and a posterolateral dislocation of the radial head.
• Type III:  Fracture of the ulnar metaphysis with a lateral or anterolateral dislocation of the radial head.
  Type IV:  Fracture of the proximal third of the radius and ulna at the same level with an anterior dislocation of the radial head.  Very difficult to control by closed means.  Require fixation of radius and ulna to provide level arm to reduce radial head.  In young pts this can be done with IM pins in radius and ulna.  Adults = ORIF  (Gibson, JBJS 74B:780;1992)
• AO Classification

Monteggia Fx Associated Injuries / Differential Diagnosis

• Isolated ulna shaft fracture.
• Radius and ulna shaft fracture.
• Galeazzi Fracture
• Elbow dislocation
• "Terrible triad" (coronoid fracture, radial head fracture, elbow dislocation)
• Olecranon fracture / dislocation
• Posterolateral rotatory instability
• Radial head fracture
• Coronoid fracture
• Monteggia Fracture

Monteggia Fx Complications

• Nonunion
• Malunion
• PIN palsy: most common nerve injury, more common with Bado Type II lesions (Jessing P, Acta Orthop Scand 46:601:1975)

Monteggia Fx Follow-up Care

• (Konrad GG, JBJS 2007:89Br:354).

Monteggia Fx Review References

• Egol KA and Koval KJ in Fractures in Adults, 6th ed, 2006
• OKU Shoulder and Elbow 2
• RING D, JBJS 1998;80A:1733 °