2018 Oct. 102 (Suppl 1):93-102. - medullary nail in this location may not fill the canal and may thus provide less than rigid fixation; J Pediatr Orthop. [QxMD MEDLINE Link]. Monteggia described a fracture of the proximal third of the ulna with anterior dislocation of the radial head from both the proximal radioulnar and radiocapitellar joints. of flexion; [15] The mean postoperative increase in MEPI score was 30. The end result is a disrupted interosseous membrane proximal to the fracture, a dislocated PRUJ, and a dislocated radiocapitellar joint. The radial head should point towards the capitellum on all radiographs of the elbow. Melvin P. Rosenwasser, MD (CSOT #21, 2016), Frontiers in Upper Extremity Surgery - 2016, Monteggia - Alfred W. Hess, MD (Frontiers #16, 2016), Monteggia Fracture Dislocation - Everything You Need To Know - Dr. Nabil Ebraheim, Undecided These injuries are relatively uncommon, accounting for fewer than 5% of all forearm fractures. These ligaments stretch or rupture during radial head dislocation. Ruchelsman DE, Pasqualetto M, Price AE, Grossman JA. - ref: Repair of Bado II Monteggia Fracture: Case Presentation and Surgical Technique. Late reconstruction of chronic Monteggia lesions in children can be complicated and unpredictable. - when dx is delayed < 3 months, ORIF is indicated; Forearm fractures in children. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. - radiohumeral ankylosis The original description is of a "traumatic lesion distinguished by a fracture of the proximal third of the ulna and an anterior dislocation of the proximal epiphysis of the radius"" [1]. 2023 Lineage Medical, Inc. All rights reserved, PediatricsMonteggia Fracture - Pediatric. This principle also applies to aGaleazzi fracture, which is a fracture of the distal radius with concomitant dislocation of the distal radioulnar joint (DRUJ). Treatment may be closed reduction and casting for length stable ulna fractures with a stable radiocapitellar joint. Am J Orthop (Belle Mead NJ). Indications for treatment of Monteggia fractures (seeTreatment) are based on the specific fracture pattern and the age of the patient (ie, pediatric or adult). Purpose: Monteggia variant defined as Monteggia fracture dislocation with radial head or neck fracture, coronoid fracture, ulnohumeral joint dislocation or combination of these injuries. 2008 Apr. J Bone Joint Surg Am. - type I, III, and IV lesions are held in 110 deg. 19 (74):164-167. Evans EM. The Monteggia lesion. You can rate this topic again in 12 months. 2015 Nov. 31 (4):565-80. J Bone Joint Surg Am. 2018 Feb. 104 (1S):S113-S120. Acute pediatric Monteggia fractures: A. conservative approach to stabilization. [14] Osteoarthritic changes were seen at the radiohumeral joint in four patients. 4 (2):167-72. Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). Are you sure you want to trigger topic in your Anconeus AI algorithm? Bruce HE, Harvey JP, Wilson JC Jr. Monteggia fractures. 110 West Rd., Suite 227 16 (3):131-5. 2011 Feb. 77 (1):21-6. encoded search term (Monteggia Fracture) and Monteggia Fracture. Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. Are you sure you want to trigger topic in your Anconeus AI algorithm? (1/8), Undecided Li H, Cai QX, Shen PQ, Chen T, Zhang ZM, Zhao L. Posterior interosseous nerve entrapment after Monteggia fracture-dislocation in children. [QxMD MEDLINE Link]. Adults and unstable injuries generally require ORIF of the ulna. [10] studied the etiology of Monteggia fractures on cadavers by stabilizing the humerus in a vise and subjecting different forces to the forearm. Scary Elbows: The Proximal Monteggia with David Stanley | OTS, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, Monteggia Injury: Case of the Week - Joanne Wang, MD, 2016 Current Solutions in Orthopaedic Trauma, Case Presentation: Chronic Monteggia Fx / Ulnar Nonunion. This is a report of two rare variants of Monteggia fracture-dislocation. Monteggia-type elbow fractures in childhood. The median and ulnar nerves enter the antecubital fossa just distal to the elbow. Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. Subluxation of the radial head occurred in three patients; one patient experienced transient palsy of the posterior interosseous nerve; and distortion of the radial head (which had no bearing on function) occurred in three. - this is esp true on the lateral projection; - type II lesions with posterior dislocations should be maintained in about 70 deg. The posterior interosseous nerve travels around the neck of the radius and dives under the supinator as it courses into the forearm. [2 . [QxMD MEDLINE Link]. [5] The mean arc of forearm rotation increased from 145 to 149. It is the character of the ulnar fracture, rather than the direction of radial head dislocation, that is useful in determining the optimal treatment of Monteggia fractures in both children and adults. The first case is a combined type III Monteggia injury with ipsilateral Type II Salter-Harris injury of the distal end radius fracture with metaphyseal fracture of the In 17 of the 22 patients, the radial head remained in a completely reduced position, and it was subluxated in five patients. Wong JC, Getz CL, Abboud JA. Although most pediatric fracture patterns can be managed conservatively with closed reduction and long arm casting, most adult fractures require open reduction and internal fixation (ORIF). Rockwood CA, Green DP, Bucholz R, eds. 2020 Mar. Take great care to avoid injury to the underlying skin. - achieved w/ forarm in full supination, & longitudinal traction; - dislocation of radial head may be missed, eventhough frx of ulna is obvious (need AP, lateral and olbique X-rays of elbow) Philadelphia: Lippincott Williams & Wilkins; 2012: 351-65. Problems with the elbow related to fractures of the coronoid process and the radial head, which are common with Bado type-II Monteggia fractures, remain the most challenging elements in the treatment of these injuries. In: Beaty JH, Kasser JR,eds. Dhoju D, Parajuli B. Functional Outcome of Pediatric Monteggia Fracture Dislocation Treated Surgically in a Tertiary Care Centre of Nepal. According to the classification of Bado, there were seven type-I, thirty-eight type-II, one type-III, and two type-IV injuries. - hence, these patients will require close follow up; - Treatment: [QxMD MEDLINE Link]. Floriano Putigna, DO, FAAEM Staff Physician, Florida Emergency Physicians, Inc, and Florida Hospital Monteggia fractures account for fewer than 5% of forearm fractures, with published literature supporting figures in the range of 1-2%. of flexion for 6 weeks; - Delayed Dx: al. Delpont M, Louahem D, Cottalorda J. Monteggia injuries. You are being redirected to 2013. EVANS EM. (0/1), Level 5 Other important complications included proximal radioulnar synostosis in three patients, ulnar malunion in three, posterolateral rotatory instability of the ulnohumeral joint in one, and instability of the distal radioulnar joint in one. [QxMD MEDLINE Link]. Breaks, Fractures, and Dislocations Center, Association of Medical Consultants of Mumbai, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society. [QxMD MEDLINE Link]. The records concerning ten consecutive years of experience with Monteggia fractures in adult patients at a level-one trauma center were retrospectively reviewed. - exam: Epub 2012 Oct 10. Application of this eponym to all injuries with radiocapitellar subluxation or dislocation has led to some confusion. Monteggia fracture - fracture of the proximal 1/3 of the ulnar shaft accompanied by the dislocation of the radial head. The radial head dislocation may not be apparent and will possibly be missed if the elbow is not included in the radiograph. 2023 Lineage Medical, Inc. All rights reserved. J Clin Diagn Res. The eponymous term "Monteggia fracture" is most precisely used to refer to dislocation of the proximal radioulnar joint in association with a forearm fracture. [7] Interestingly, he described this injury pattern in the pre-Roentgen era solely on the basis of the history of injury and the physical examination findings. J Hand Surg Am. It is named after Giovanni Battista Monteggia. Introduction Giovanni Battista Monteggia, a surgical pathologist and public health official in Milan, first described the Monteggia fracture in 1814. different treatment protocol for children, may be part of complex injury pattern including, Fracture of the proximal or middle third of the ulna with, Fracture of the ulnar metaphysis (distal to coronoid process) with, Fracture of the proximal or middle third of the, Jupiter Classification of Type II Monteggia Fracture-Dislocations, Fracture extending to distal half of ulna, may or may not be obvious dislocation at radiocapitellar joint, may be loss of ROM at elbow due to dislocation, radial deviation of hand with wrist extension, AP and Lateral of elbow, wrist, and forearm, helpful in fractures involving coronoid, olecranon, and radial head, must ensure stabilty and anatomic alignment of ulna fracture, acute fractures which are open or unstable (long oblique), most Monteggia fractures in adults are treated surgically, ORIF of ulna shaft fracture, open reduction of radial head, failure to reduce radial head with ORIF of ulnar shaft only, Monteggia "variants" with associated radial head fracture, lateral decubitus position with arm over padded support, midline posterior incision placed lateral to tip of olecranon, develop interval between flexor carpi ulnaris and anconeus along ulnar border proximally, and interval between FCU and ECU distally, with proper alignment of ulna radial head usually reduces and open reduction of radial head is rarely needed, failure to align ulna will lead to chronic dislocation of radial head, treatment based on involved components (radial head, coronoid, LCL), if no improvement obtain nerve conduction studies, usually caused by failure to obtain anatomic alignment of ulna, If diagnosis is delayed greater than 2-3 weeks complication rates increase significantly, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. More than 150 years later, in 1967, Bado coined the term Monteggia lesion and classified the injury into the following four types In 1991, Anderson and Meyer used the following criteria to evaluate forearm fractures and their prognosis Advances in radiography and fracture research have helped define, classify, and guide operative management.
