Monteggia Fracture
synonyms:
Monteggia Fracture ICD-9
Monteggia Fracture Etiology / Epidemiology / Natural History
- Definition: Ulnar shaft fx with radial head dislocation
Monteggia Fracture Anatomy
Monteggia Fracture Clinical Evaluation
Monteggia Fracture Xray / Diagnositc Tests
- a/p and lateral of the elbow and forearm
- radiocapitellar joint must be aligned anatomically in all views
Monteggia Fracture Classification / Treatment
- Bado classification
- Plastic deformation/greenstick fractures are generally stable after CR and can be treated in a LAC
- Short oblique and transverse ulnar fx are unstable = CR, IM ulnar fixation
- Long oblique / comminuted fx may require ORIF
- If radial head is irreducible by closed means, open reduction via an extended posterolateral incision is indicated. Annular ligament or posterior interosseous nerve may be entrapped and blocking reduction.
- Chronic / missed Monteggia fracture: ORIF if <12 or within 3 years of injury (Nakamura K, JBJS 2009;91A:1394)
Monteggia Fracture Associated Injuries / Differential Diagnosis
- most common nerve injury is posterior interosseous. Spinner M, Freundlich BD, Teicher J: Posterior interosseous nerve palsy as a complication of Monteggia fractures in children. Clin Orthop 1968;58:141-145.
Monteggia Fracture Complications
- ulnar malunion with chronic radial head dislocation; may lead to loss of motion, arthritis and pain. Consider ulnar osteotomy, annular ligament reconstruction, i.e. referral to pediatric hand surgeon
Monteggia Fracture Follow-up Care
Monteggia Fracture Review References
- Olney BW, Menelaus MB: Monteggia and equivalent lesions in childhood. J Pediatr Orthop 1989;9:219-223
- Wiley JJ, Galey JP: Monteggia injuries in children. J Bone Joint Surg 1985;76B:728-731.
Olney BW, Menelaus MB: Monteggia and equivalent lesions in childhood. J Pediart Orthop 1989; 219-223.°
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