Pediatric Monteggia fracture dislocations are characterized by an ulna fracture associated with a disruption of the proximal radioulnar joint and a radial head dislocation. The posterior border of the ulna should also be assessed. 2 . It is rare for an adult to have a Monteggi… Follow-up in fracture clinic needs to be in 7 days with an x-ray. He is the one who described this fracture in the early 1800’s. After having surgery there will be a restriction on range of motion on the elbow but that is normally lifted after three months. The line drawn down the shaft of the radius does not pass through the centre of the capitellum. Anterior dislocation of the radial head with fracture of the ulna shaft (diaphysis), Posterior dislocation of the radial head with fracture of the ulna shaft (diaphysis) or metaphysis, Lateral dislocation of the radial head with fracture of the ulna metaphysis, Anterior dislocation of the radial head with fracture of the shaft (diaphysis) of the ulna and radius. However, the Monteggia fracture is often still associated with various complications, poor functional outcomes and a relatively high rate of revision surgeries. Type I Monteggia fracture-dislocation (with plastic deformation of ulna). posterior interosseous nerve neurapraxia (10% of acute injuries) almost always spontaneously resolves; ... - Monteggia Fracture - Pediatric E 11/30/2015 904 . Monteggia fracture-dislocations can be easily missed on x-ray. The surgery is done to pin the fractured ulna and to stabilize the joint if necessary. fracture clinics for other potential complications. If an ulna fracture is present, always look for a radial head dislocation. It is named after Giovanni Battista Monteggia. The ulnar fracture is usually obvious, whereas the radial head dislocation can be overlooked, with potentially serious functional and medico-legal ramifications. In adults, the healing is slower and results usually not as good. relationship between anatomy and the neuropathy which is a frequent complication in Monteggia lesions. After your arm has been in a cast for several weeks your physician will order more x-rays to confirm that the healing is even and the bones are knitting together. What classification they fall into depends on the displacement of the radial head. The line drawn down the shaft of the radius does not pass through the centre of the capitellum (asterix). The radial nerve is the most commonly injured nerve (10-20%). Peripheral nerve examination needs to be documented. All Monteggia fracture-dislocations require an urgent orthopaedic assessment. 14 The radial head should align with the cap-itellum regardless of the radiographic view. The nerve injury is usually treated expectantly. What are the potential complications associated with this injury? Fracture of the proximal or middle third of the ulna with anterior dislocation of the radial head (most common in children and young adults) Type II. Monteggia fracture-dislocations typically involve a dislocation of the radial head with an associated fracture of the ulnar shaft. No complications were observed; the only complaint was salience of the ulnar plate. Major complications were defined as those requiring an unplanned second procedure (other than implant removal) or that may result in long-term disability (residual radial head subluxation/dislocation). If it is not straight, it indicates a plastic deformation injury. However if the ulna has a greenstick fracture or 'plastic bowing', deformity is mild and the fracture can be easily missed. The gold standard of treatment in adults has been open reduction and internal fixation, and closed reduction and cast immobilization in pediatrics. Monteggia Fracture-Dislocations Acute Complications Failure to make the diagnosis is the most common, acute complication of a Monteggia fracture-dislocation. The injury is usually a neuropraxia. It will be painful to move the elbow in any plane. Beaty JH, Kasser JR (Eds). How common are they and how do they occur? If identified early, these injuries will do well. Table 1: Bado classification of Monteggia fracture-dislocations. 15%. Treatment of a Monteggia fracture-dislocation is with surgery to repair the ulna fracture. This is an arm fracture in which the joint with the radial head at your elbow becomes dislocated and the ulna, one of the bones in your forearm is broken. Notice that the ulna border is not straight (shaded area). The results for six patients were presented in an earlier … The forearm may look deformed if the ulna fracture is displaced. This can affect elbow ROM. Scherl S, Schmidt A. Pediatric trauma: Getting through the night. Delayed or missed diagnosis is the most frequent complication. Monteggia fracture-dislocations consist of a fracture of the ulnar shaft with concomitant dislocation of the radial head. Reduction is always required. He is the one who described this fracture in the early 1800’s. In Rockwood and Wilkins' Fractures in Children, 7th Ed. Originally described by Giovanni Battista Monteggia in 1814, the Monteggia fracture is a fracture of the proximal ulna associated with a dislocation of the radial head. The health information provided on this web site is for educational purposes only and is not to be used as a substitute for medical advice, diagnosis or treatment. What radiological investigations should be ordered? Monteggia fracture-dislocations can be easily missed on x-ray. It is rare for an adult to have a Monteggia fracture but is most common in children between the ages of four and ten. J Bone Joint Surg Am 2010; 92(3): 756-64. This should be arranged by the consulting orthopaedic team after their reduction and stabilisation of the injury. 7 In this case report of a 35-year-old man the nerve became wrapped around an anterolaterally dislocated radial head in the course of an unsuccessful attempt as closed reduction. Periarticular ossification - this can occur in 3-7% of Monteggia fracture-dislocations. Late reconstruction is difficult and often results in … To diagnosis a Monteggia fracture the radiographer will use an x-ray machine to visualize the joints and bones in your arm. 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. Delayed diagnosis is the most frequent complication. When is reduction (non-operative and operative) required? It is associated with higher energy injuries, fractures of the radial head, and multiple attempts at manipulation. This is referred to as a, Resting your arm by elevating it higher than your heart, Cold compresses but you have to be careful not to get the cast wet. Delayed or missed diagnosis is the most frequent complication. It should be straight, not bowed. Type II Monteggia fracture-dislocations are rare. Because it is a very complex surgery you may need several surgeries to correct a Monteggia fracture. A Monteggia fracture is often managed with resetting and casting in children. Your ulna is a bone in your forearm that is broader near your elbow and tapers as it approaches your wrist. A Monteggia fracture is a severe type of broken arm that might lead to major complications if not treated quickly. Open reduction of the radial head often is necessary because of interposition of soft tissue between it and the ulna or capitellum. Complications of Monteggia fractures often result from nonanatomic or loss of fixation of the ulna fracture, leading to recurrent dislocation of the radial head. Rodríguez-Merchán EC. The immediate postoperative radiographs showed inaccurate reduction of the proximal ulnar fracture, resulting in abnormal articular congruence of the elbow joint. In children, the results of early treatment are always good, typically normal or nearly so. For children who have a type four classification they may use intramedullary wires or plate fixation to stabilize the fracture. See also: There is an ulna midshaft fracture. Fracture of the proximal or middle third of the ulna with posterior dislocation of the radial head (70 to 80% of adult Monteggia fractures) Type III. Nutritional staus. The eponym Monteggia fracture is most precisely used to refer to a dislocation of the proximal radioulnar joint in association with a forearm fracture. Figure 1: Ten year old girl with type I Monteggia fracture-dislocation. Pictures : How Monteggia Fracture Looks like? Monteggia fracture-dislocation in children. It is concluded that Monteggia lesions … A closed Monteggia fracture with comminution of the proximal ulna and luxation of the head of the radius was present (Fig. Clin Ortho Relat Res 2005; 432: 65-72. A radial head dislocation is evident as shown by the radiocapitellar line. Compartment syndrome, which is an increase in pressure in one of your body’s compartments that contains nerves and muscles.

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