Rockwood CA, Green DP, Bucholz R, eds. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. 2022 Feb 1. J Bone Joint Surg Br. Key words: Monteggia's fracture; Radius fracture; Ulna (4/7). Findings associated with the concomitant radial head dislocation are often subtle and can be overlooked. 1974 Dec. 56 (8):1563-76. [15] The mean postoperative increase in MEPI score was 30. The mean Broberg and Morrey score increased from 89 points to 94 points, and the median Disabilities of the Arm, Shoulder, and Hand (DASH)score was 7 points at long-term follow-up. Cast treatment with the elbow extended. Share cases and questions with Physicians on Medscape consult. Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. If the elbow is flexed, the chance of a type II or III lesion is greater. [6] Injuries to the anterior interosseous branch of the median nerve and the ulnar nerve also have been reported. Are you sure you want to trigger topic in your Anconeus AI algorithm? 3rd ed. The Monteggia lesion. [QxMD MEDLINE Link]. - posterior or posterolateral dislocation of radial head (or frx); 2009 Nov. 34 (9):1618-24. Monteggia Fractures in the pediatric population are defined as proximal ulna fractures or plastic deformation of the ulna with an associated radial head dislocation. J Pediatr Orthop 2015; 35 (2) 115-120. - attempt to palpate radial head (ant, post, or lateral); [1], The first challenge is correctly assessing the extent and nature of the injury. (0/1), Level 1
Evans in 1949 - Mechanism: This fracture refers to an intraarticular fracture that separates the palmar ulnar aspect of the first metacarpal base from the remaining first metacarpal. Anderson LE, Meyer FN. (16/80), Level 5
al. This injury is frequently confused with anterior Monteggia lesions by virtue of the readily apparen The fracture of the radial head was treated with either complete or partial excision of the fragments in twelve patients (with replacement with a silicone prosthesis in two), open reduction and internal fixation in ten patients, and no intervention in four patients. Ramski, D., Hennrikus, W., Bae, D., et. [QxMD MEDLINE Link]. Are you sure you want to trigger topic in your Anconeus AI algorithm? [4] The radial head articulates with the humeral capitellum and the radial notch of the proximal ulna. Surgical Management of Complex Adult Monteggia Fractures. 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; 2009 Jun. Bruce HE, Harvey JP, Wilson JC Jr. Monteggia fractures. Monteggia Fracture } Drake LeBrun MD Experts 3 Bullets 65 3.4 ( 5 ) 3 Images Snapshot A 35-year-old man presents to the emergency room for severe right elbow and forearm pain after sustaining a blunt injury to his right arm. Vol 2: 520. There were twenty-five women and twenty-three men, and the average age was fifty-two years (range, eighteen to eighty-eight years). A Monteggia fracture involves a fracture of the ulna with disruption of the proximal radio-ulnar joint (PRUJ) and radiocapitellar dislocation (Bado, 1967). Vol 1: Nakamura K, Hirachi K, Uchiyama S, Takahara M, Minami A, Imaeda T, et al. This is a report of two rare variants of Monteggia fracture-dislocation. You can rate this topic again in 12 months. of flexion for 6 weeks; - Delayed Dx: It is named after Giovanni Battista Monteggia. (20/80). Monteggia lesions in children and adults: an analysis of etiology and long-term results of treatment. The close proximity of these nerves may lead to injuries when a Monteggia fracture occurs. [QxMD MEDLINE Link]. Philadelphia: Lippincott Williams &Wilkins; 2010: 446-74. (0/8). Monteggia fractures are one third as common as the more . Datta T, Chatterjee N, Pal AK, Das SK. Monteggia fractures account for fewer than 5% of forearm fractures, with published literature supporting figures in the range of 1-2%. Whenever a fracture of a long bone is noted, the joints above and below should be evaluated with radiographs in orthogonal planes (planes at 90 angles to each other). Telephone: 410.494.4994. In his classic 1943 text, Watson-Jones stated that "no fracture presents so many problems; no injury is beset with greater difficulty; no treatment is characterized by more general failure." Orthopaedic Specialists of North Carolina. [QxMD MEDLINE Link]. 110 West Rd., Suite 227
[QxMD MEDLINE Link]. Bado JL. Steven I Rabin, MD, FAAOS Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Musculoskeletal Services, Dreyer Medical Clinic 40 (3):e216-e221. The remaining patients had fixation with a plate and screws. In 17 of the 22 patients, the radial head remained in a completely reduced position, and it was subluxated in five patients. Proximal radius dislocations in skeletally immature teenagers and children occur in the setting of a spectrum of ulnar injuries that often do not follow classic adult patterns. Epidemiology: Are you sure you want to trigger topic in your Anconeus AI algorithm? [QxMD MEDLINE Link]. Events. (6/78), Undecided
- ulnar frx is treated w/ compression plate (esp in proximal third) 2021 Apr-Jun. If you log out, you will be required to enter your username and password the next time you visit. In 1991, Anderson and Meyer used the following criteria to evaluate forearm fractures and their prognosis - apex of angular deformity of ulna usually indicates direction of radial head dislocation; - Reduction: Instituzioni Chirrugiche. (0/1), Level 2
- reduction: At the most recent follow-up examination, which was performed after all of the reoperations and reconstructive procedures had been done, the average score according to the system of Broberg and Morrey was 86 points (range, 15 to 100 points). The result was excellent for eighteen patients, good for twenty-two, fair for two, and poor for six. - Monteggia Fractures in Children. [14] Osteoarthritic changes were seen at the radiohumeral joint in four patients. [QxMD MEDLINE Link]. Monteggia Fractures in Pediatric and Adult Populations, Clifford R. Wheeless, III, M.D. Neural injuries are generally traction injuries and result from stretching around the displaced bone or from energy dispersed during the initial injury. Monteggia fracture-dislocation is rare in children 2,3,4. Once the radial head is reduced in closed injuries, surgical treatment may be delayed until the patient is stable and the surgery may be performed in a more elective fashion. anteriorangulation (usually proximal third); 2014 Jun. The poor re-sults usually relate to intraarticular damage, coronoid frac-tures and comminution of the ulna and radial head fractures.
- Mechanism: - proposed mechanisms include direct blow & hyperpronation injuries as well- as the hyperextension theory; Bae, D. Successful strategies for managing Monteggia Injuries. - associated nerve injury: Unstable (complete) ulnar fractures are prone to residual or recurrent displacement and may require operative fixation. Kim JM, London DA. Data Trace is the publisher of
(0/7), Level 3
[Full Text]. - myositis ossificans, The challenge of Monteggia-like lesions of the elbow mid-term results of 46 cases, Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). Undecided
Removal of forearm plates. J Pedtiatr Orthop 2016; 35:S67-S70. - recurrent radial head dislocation 9 (8):[QxMD MEDLINE Link]. [10] studied the etiology of Monteggia fractures on cadavers by stabilizing the humerus in a vise and subjecting different forces to the forearm. [1] The injury is typically caused by axial loading on a partially flexed metacarpal and may be associated with other carpal bone fractures or ligament injuries. - proposed mechanisms include direct blow & hyperpronation injuries as well-as the 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. Delpont M, Louahem D, Cottalorda J. Monteggia injuries. Monteggia GB. Chin J Traumatol. Copyright 2023 Lineage Medical, Inc. All rights reserved. Treatment can be isolated closed reduction in the pediatric population (if radiocapitellar joint remains stable). Prompt recognition of this injury is imperative. PENROSE JH. Monteggia fractures and their variants are often misdiagnosed, however, because of the numerous atypical presentations of this injury in children. J Pediatr Orthop. In a retrospective study on the functional and radiologic long-term outcome of ORIF in 11 skeletally mature patients with Bado type I Monteggia fractures, Guitton et al found that the mean arc of elbow flexion increased from 110 at early follow-up to 120 at late follow-up. Anterior elbow dislocations occur most often as a fracture-dislocation in which the distal humerus is driven through the olecranon, thereby causing a complex, comminuted fracture of the proximal ulna. Nine patients, all of whom had a Bado type-II fracture, needed a reoperation within three months after the initial operation; five had revision of a loose ulnar fixation device, three had resection of the radial head, and one had removal of a wire that had migrated from the radial head into the elbow articulation. 2013. - posterior Monteggia frx is reduced by applying traction to forearm w/ the forearm in full extension; - r/o tear of the annular ligament Monteggia fracture-dislocations remain a relatively uncommon injury. [5] The ulna provides a stable platform for rotation of the radius and forearm. - key is to obtain length and alignment, which then allows the radial head to be reduced; Tan SHS, Low JY, Chen H, Tan JYH, Lim AKS, Hui JH. - when dx is delayed < 3 months, ORIF is indicated; Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. Modified technique for correction of isolated radial head dislocation without apparent ulnar bowing: a retrospective case study. (0/7), Level 2
Waters PM, Bae DS, eds. 2020 Sep. 40 (8):387-395. A 45-year-old male falls off his motorcycle and injures his arm. Foran, I., Upasani, V., Wallace, C., et.al. In a study evaluating long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in 22 children (14 boys, 8 girls; age range, 4 y to 15 y 11 mo), Nakamura et al noted that the postoperative Mayo Elbow Performance Index (MEPI) at follow-up ranged from 65 to 100, with 19 excellent results, two good results, one fair result, and zero poor results. 91 (6):1394-404. (0/8), Level 2
Leonidou A, Pagkalos J, Lepetsos P, Antonis K, Flieger I, Tsiridis E, et al. Towson, MD 21204
: A retrospective study. 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). J Pediatr Orthop. These injuries are relatively uncommon, accounting for fewer than 5% of all forearm fractures. [11, 12] Of the Monteggia fractures, Bado type I has been reported to be the most common (59%), followed by type III (26%), type II (5%), and type IV (1%). 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. Monteggia fractures account for fewer than 5% of forearm fractures, with published literature supporting figures in the range of 1-2%. Diagnosis can be made with plain radiographs of the elbow. 28 (19):e839-e848. Monteggia fractures and their variants are often misdiagnosed, however, because of the numerous atypical presentations of this injury in children. Advances in radiography and fracture research have helped define, classify, and guide operative management. The keys to successful diagnosis of a Monteggia fracture are clinical suspicion and radiographs of the entire forearm and elbow. Wang C, Su Y. "A Monteggia fracture with apex anterior ulnar shaft fracture is associated with an anterior radial head dislocation. Kopriva J, Awowale J, Whiting P, Livermore A, Siy A, Hetzel S, et al. (1/7), Level 1
Orthopedics. (0/1), Level 5
A review of the complications, Does a Monteggia variant lesion result in a poor functional outcome? - anterior dislocation of the radial head; Clinical effect of manual reduction of humeroradial joint in the treatment of type - fresh Monteggia fracture in children. The character of the ulnar fracture is useful in determining optimal treatment. Canton G, Hoxhaj B, Fattori R, Murena L. Annular ligament reconstruction in chronic Monteggia fracture-dislocations in the adult population: indications and surgical technique. Type II lesions that are associated with ulnohumeral dislocation have been noted to have outcome scores with greater disability than those without ulnohumeral dislocation. Monteggia fracture-dislocations in children. - ref: Repair of Bado II Monteggia Fracture: Case Presentation and Surgical Technique. (2/7), Level 4
A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. Data Trace Publishing Company
The investigators evaluated outcomes on the basis of the 100-point MEPI, radiology, and questionnaire. Separate radiographs should be taken of the elbow. Waters PM. Orthopedics. Musculoskelet Surg. The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius. 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 Bado initially described and classified these injuries. [11, 12] Of the Monteggia fractures, Bado type I has been reported to be the most common (59%), followed by type III (26%), type II (5%), and type IV (1%). Fracture of the upper end of the ulna associated with dislocation of the head of the radius in children. (1/8), Level 3
Wong JC, Getz CL, Abboud JA. - this ordinarily requires 6-10 wks depending on the age of pt; J Pediatr Orthop. The Galeazzi fracture is a fracture of the middle to distal one-third of the radius associated with dislocation or subluxation of the distal radioulnar joint (DRUJ). J Bone Joint Surg Am. With careful definition, specific subsets of patients may benefit from consideration as a separate type of Monteggia injury. Bennett fracture is the most common fracture involving the base of the thumb. - type II lesions with posterior dislocations should be maintained in about 70 deg. 36 Suppl 1:S67-70. The present multicenter retrospective study compared results for the Bouyala procedure with versus without plasty of the annular ligament of the radial head in evolved radial head lesion (Monteggia lesion), assessing the benefit of associating ligamentoplasty to ulnar osteotomy. - Type III - 20% The Orthobullets Podcast In this episode, we review the high-yield topic of Monteggia Fractures from the Trauma section. Ruchelsman DE, Pasqualetto M, Price AE, Grossman JA. Stable anatomic reduction of the ulnar fracture results in anatomic reduction of the radial head. 2019 Feb. 31 (1):54-60. Evans EM. Bae DS. The treating physician may reduce an unrecognized dislocation while reducing or immobilizing the ulna fracture. 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. If one of the forearm bones is injured, injury should be looked for in the other bone and in associated joints of the forearm, elbow, and wrist. (1/8), Undecided
LIVIN' ON THE MD EDGE: Drive, Chip, and Putt Your Way to Osteoarthritis Relief, Osteoporosis and Osteopenia: Latest Treatment Recommendations, Osteoporosis: A Bare-Bones Guide to Diagnosis and Treatment. JAMA 1940;115:1699-1705. Monteggia fractures in adults: long-term results and prognostic factors. 8 (6):LC01-4. Bado believed that the type III lesion, the result of a direct lateral force on the elbow, was primarily observed in children. Orthop Traumatol Surg Res. Monteggia fracture-dislocation in children. The Monteggia lesion. (1/1), Level 4
Must have high index of suspicion high incidence of missed injuries (Waters, 2010), Appropriate radiographic imaging is essential to making the correct diagnosis, Be aware of plastic deformation of the ulna. 2023 Lineage Medical, Inc. All rights reserved. - bony ankylosis may be more disabling than the joint instability plastic deformation of the ulna without obvious fracture, pain, swelling, and deformity about the forearm and elbow, isolated radial head dislocations almost never occur in pediatric patients, a line down the radial shaft should pass through the center of the capitellar ossification center, radial head is stable following reduction, radial head will reduce spontaneously with reduction of the ulna and restoration of ulnar length, for Type I, elbow flexion is the main reduction maneuver, if reduction of radiocapitellar joint is unsuccessful, annular ligament is most common block to reduction, radial head is not stable following reduction, ulnar length is not stable (unable to maintain ulnar length), older patients 10y if closed reduction is not stable, symptomatic individuals (pain, loss of forearm motion, progressive valgus deformity) who had delayed treatment or missed diagnosis, open reduction of radial head through a lateral approach if needed in chronic (>2-3 weeks old) Monteggia fractures where radial head still retains concave structure, annular ligament reconstruction almost never required for acute fractures, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). Treatment may be closed reduction and casting for length stable ulna fractures with a stable radiocapitellarjoint. Evaluation of outcome of corrective ulnar osteotomy with bone grafting and annular ligament reconstruction in neglected monteggia fracture dislocation in children. Richard L Ursone, MD Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, Brooke Army Medical Center J Bone Joint Surg Br. Is Bone Mineral Density Testing Underused in Prostate Cancer Care? 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. Guitton TG, Ring D, Kloen P. Long-term evaluation of surgically treated anterior monteggia fractures in skeletally mature patients. [QxMD MEDLINE Link]. Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). Clin Orthop Relat Res. J Pediatr Orthop. Monteggia fractures are one third as common as the more familiar Galeazzi fractures. Bado type III lesion with lateral displacement of the radial head. (3/76), Level 1
Surgical Management of Missed Pediatric Monteggia Fractures: A Systematic Review and Meta-Analysis. Pronation injuries of the forearm, with special reference to theanterior Monteggia fracture. [1] [2] Causes Mechanisms include: Fall outstretched hand with the forearm in excessive pronation (hyper-pronation injury). Steven I Rabin, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Fracture Association, American Orthopaedic Association, AO Foundation, Chicago Metropolitan Trauma Society, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society, Mid-America Orthopaedic Association, Orthopaedic Trauma AssociationDisclosure: Nothing to disclose. Undecided
[14]. (1/1), Level 4
The Monteggia fracture with posterior dislocation of the radial head. 1982 Jul. A 12-year-old male sustains an ulnar fracture with an associated posterior-lateral radial head dislocation. Fractures of the forearm with dislocation of the proximal radioulnar joint are known as Monteggia frac tures26'847. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTIzMTQzOC1vdmVydmlldw==, Type I - Fracture of the proximal or middle third of the ulna with anterior dislocation of the radial head (see the first and second images below), Type II - Fracture of the proximal or middle third of the ulna with posterior dislocation of the radial head (see the third and fourth images below), Type III - Fracture of the ulnar metaphysis with lateral dislocation of the radial head (see the fifth and sixth images below), Type IV - Fracture of the proximal or middle third of the ulna and radius with anterior dislocation of the radial head (see the seventh image below), Excellent - Union with less than 10 loss of elbow and wrist flexion/extension and less than 25% loss of forearm rotation, Satisfactory - Union with less than 20 loss of elbow and wrist flexion/extension and less than 50% loss of forearm rotation, Unsatisfactory - Union with greater than 30 loss of elbow and wrist flexion/extension and greater than 50% loss of forearm rotation, Failure - Malunion, nonunion, or chronic osteomyelitis. A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. Kathmandu Univ Med J (KUMJ). 2020 Aug. 23 (4):233-237. J Am. What are Monteggia fractures and how are they classified and treated? Ulnar fracture with late radial head dislocation: delayed Monteggia fracture. 2012 Mar 7. Undecided
Hume fracture - fracture of the olecranon accompanied by anterior dislocation of the radial head. Late reconstruction of chronic Monteggia lesions in children can be complicated and unpredictable. This principle also applies to aGaleazzi fracture, which is a fracture of the distal radius with concomitant dislocation of the distal radioulnar joint (DRUJ). Unrecognized dislocations may result from reduction of the dislocated radius prior to presentation. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. The records concerning ten consecutive years of experience with Monteggia fractures in adult patients at a level-one trauma center were retrospectively reviewed. 1967; 50:71-86. [QxMD MEDLINE Link]. - hence, these patients will require close follow up; - Treatment: Medscape Education. encoded search term (Monteggia Fracture) and Monteggia Fracture. Floriano Putigna, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic AssociationDisclosure: Nothing to disclose. 2023 Lineage Medical, Inc. All rights reserved, PediatricsMonteggia Fracture - Pediatric. This website also contains material copyrighted by 3rd parties. AP and lateral radiographs reveal a proximal ulnar shaft fracture, 30 degrees apex anterior, and a radial head dislocation. Di Gennaro GL, Martinelli A, Bettuzzi C, Antonioli D, Rotini R. Outcomes after surgical treatment of missed Monteggia fractures in children. The anular (annular) and radial collateral ligaments stabilize the radial head. The ulna was fixed with a tension band-wire construct supplemented with screws in three patients (all of whom had a Bado type-II fracture). Monteggia fracture - fracture of the proximal 1/3 of the ulnar shaft accompanied by the dislocation of the radial head. Please confirm that you would like to log out of Medscape. anterior dislocation of radial head; [QxMD MEDLINE Link]. In: Beaty JH, Kasser JR,eds. Are you sure you want to trigger topic in your Anconeus AI algorithm? Monteggia fractures in pediatric and adult populations. Li H, Cai QX, Shen PQ, Chen T, Zhang ZM, Zhao L. Posterior interosseous nerve entrapment after Monteggia fracture-dislocation in children. Trauma10531822MonteggiaFracturesAuthor:Tracy JonesIntroductionInjury defined asproximal 1/3 ulnar fracture with associated radial head dislocation/instabilityEpidemiologyrare in adultsmore common in childrenwith peak incidence between 4 and 10 years of agedifferent treatment protocol for childrenAssociated injuriesmay be part of complex injury Type in at least one full word to see suggestions list, 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. Most nerve injuries are neurapraxias and typically resolve over a period of 4-6 months. [QxMD MEDLINE Link]. Bado type II lesion after open reduction and internal fixation. Robert J Nowinski, DO Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio Stitgen A, McCarthy JJ, Nemeth BA, Garrels K, Noonan KJ. Tan JW, Mu MZ, Liao GJ, Li JM. Adults and unstable injuries generally require ORIF of the ulna. For patient education resources, see theBreaks, Fractures, and Dislocations Center, as well asBroken Arm,Broken Elbow, andElbow Dislocation. - treated by reduction and stabilization of ulna followed by reduction of radial head via supination & direct pressure; [QxMD MEDLINE Link].
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