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Monteggia Fracture S52.279A 813.03

 

synonyms:

Monteggia Fracture ICD-10

 

A- initial encounter for closed fracture

B- initial encounter for open fracture type I or II

C- initial encounter for open fracture type IIIA, IIIB, or IIIC

D- subsequent encounter for closed fracture with routine healing

E- subsequent encounter for open fracture type I or II with routine healing

F- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing

G- subsequent encounter for closed fracture with delayed healing

H- subsequent encounter for open fracture type I or II with delayed healing

J- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

K- subsequent encounter for closed fracture with nonunion

M- subsequent encounter for open fracture type I or II with nonunion

N- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

P- subsequent encounter for closed fracture with malunion

Q- subsequent encounter for open fracture type I or II with malunion

R- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

S- sequela

Monteggia Fracture ICD-9

  • 813.03 Monteggia's Fracture

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.°