All Monteggia fracture-dislocations require an urgent orthopedic assessment. Reduction is always required. Delayed or missed diagnosis is the most frequent. Monteggia fractures account for approximately 1% to 2% of all forearm fractures. Distal forearm fractures are far more frequent than midshaft. Monteggia fracture-dislocations consist of a fracture of the ulnar shaft with concomitant dislocation of the radial head. The ulnar fracture is usually obvious.
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Examination of the proximal and distal joint should be performed to identify concomitant injuries. Eur J Trauma Emerg Surg. They may eventually present as chronic radial head dislocations with ulna malunion and require technically difficult corrective osteotomy and annular ligament reconstruction. The posterior interosseous nerve can also be injured due to its proximity to the radial head. Pediatrics Children usually have better overall outcomes than adults.
Fracture of the proximal or middle third of the ulna and radius with dislocation of the radial head in any direction.
Radial head dislocation and subtle ulnar bow. Care should be taken to stay anterior to and preserve the lateral collateral ligament. Retrieved from ” https: MusculoskeletalTraumaPaediatrics. Edit article Share article View revision history. Operative fixation must address ulnar length, alignment and rotation and provide adequate stability for early range of motion.
Epub Dec 8. Reduction is always required and is urgent. See fracture clinics for other potential complications. Excellent figures illustrate the article. The proximal radial head articulates with the capitellum of the humerus radiocapitellar jointrotating within the annular ligament during pronation and supination. Most pediatric Monteggia fractures can be treated via closed means. Management of the radiocapitellar joint In the vast majority of both pediatric Monteggia variants, reduction of the ulna leads to spontaneous reduction of the radial head.
These types depend on the direction of the radial head dislocation. The ulna fracture is addressed first. Type I Monteggia fracture-dislocation.
An upper arm tourniquet should be placed, and the arm should be prepped and draped as high above the elbow as possible. Views Read Edit View history.
Monteggia fracture – Wikipedia
To access free multiple choice questions on this topic, click here. Posterior dislocation of the radial head with fracture of the ulna shaft diaphysis or metaphysis. Case 3 Case 3. Of eight patients that presented late, two had poor results and secondary procedures. Other indications for prompt feacture include: HPI – Fell from her height.
Giovanni Battista Monteggia Cancer Therapy Advisor Weekly Highlights. Once clinical and radiographic healing has occurred, generally after weeks, the cast is removed and gradual return to activities is encouraged.
An accompanying radial head fracture is common. In adults, treatment and outcomes depend on concomitant injury to stabilizing structures of the elbow. Treatment after delayed diagnosis is much more complex and the outcomes are much less satisfactory.
What do they look like – clinically?
What is the usual ED management for this fracture? Successful Strategies for Managing Monteggia Injuries. Josten C, Freitag S. What management should be offered? L6 – years in practice. Children should be placed in a well-molded long-arm cast after open or closed reduction.
Definitive fixation with frzcture appropriate plate is then completed. Since the radial head provides a degree of stability to the elbow, only very small and undisplaced fractures may be treated closed. In the typical apex volar ulna deformity with anterior radius dislocation, the forearm should be placed in supination with the elbow flexed to 90 degrees. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC.
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Evaluation and Management of Monteggia Fractures – Cancer Therapy Advisor
Lateral dislocation of the radial head with fracture of the ulna metaphysis. Diagnostic Workup History and physical exam begins fractire assessment. In the adult population, rehabilitation will be predicated upon elbow stability.
The elbow joint is particularly susceptible to loss of motion.