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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The ulnar fracture is usually obvious, whereas the radial head dislocation can be overlooked, with potentially serious functional and medico-legal ramifications. Please login to add comment. Definitive fixation with an appropriate plate is then completed.
J Hand Surg Am. Pediatrics Children usually have better overall outcomes than adults.
Of eight patients that presented late, two had poor results and secondary procedures. Questions To access free multiple choice questions on this topic, click here.
How important is this topic for clinical practice? Ten year old girl with type I Monteggia fracture-dislocation.
Lateral monteggla elastic nail. Most of these fractures will be treatable non-operatively. Which direction is the radial head most likely dislocated? This holds true for all projections, and whether the radial head is ossified or not. Surgical Technique Patient set—up In adults, operative treatment is usually performed under regional blockade and general anesthesia.
Distally, the radius connects with the scaphoid and lunate bones of the wrist. Monteggia fracture-dislocation in children.
Fracture, Monteggia – StatPearls – NCBI Bookshelf
Difficulty in management and outcomes increases with Babo type 2 fractures and when associated with other comorbid fractures radial head and coronoid process fractures.
The posterior interosseous nerve can also be injured due to its proximity to the radial head. When there is no stable fragment attached to the radial neck to build to, a precontoured plate may be used fix the head fragment to the shaft.
Patient denied any other trauma. Summary The Monteggia fracture involves a fracture of the ulna with an associated disruption of the radiocapitellar joint. HPI – 12 yo boy presents with Left elbow pain and a history of an ulna shaft fracture 3 years ago. Giovanni Battista Monteggia Athletes and manual workers may require more prolonged rehabilitation.
Additional radiographs of the distal wrist and proximal elbow should be obtained with any suspicion of coexistent injury. Most pediatric Monteggia fractures can be treated via closed means.
Review Fracture, Galeazzi [StatPearls. Johnson ; Michael Silberman. These risk factors correlate with a bimodal occurrence with the highest incidence occurring in young males The most common associated motor deficit is a posterior interosseous nerve palsy. National Center for Biotechnology InformationU. He continued to have pain in the lateral aspect of his elbow, with an associated prominence anterolaterally. StatPearls Publishing; Jan. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC.
Lateral x-ray of Monteggia type IV fracture in a six year old boy, as evident by dislocation of the radial head with fractures of both the shafts of the radius and ulna. There are four types depending upon displacement of the radial head: Case 3 Case 3. Long oblique or comminuted fractures lack stability, and loss of ulnar length leads to difficulty keeping the radial head reduced. StatPearls Publishing ; Jan.
PMC ] [ PubMed: Fractures and cartilage injuries Sx2— Radiocapitellar pins should be avoided whenever possible. HPI – At age 26, patient endured a motorcycle crash in October of In children, the results of early treatment are always good, typically normal or nearly so. The results of treatment of 36 pediatric Monteggia fractures. The Problem The Monteggia fracture, or fracture of the proximal third ulna with associated subluxation or dislocation of the radial head, in fact includes a wide variety of injuries to the proximal articulations between the humerus, radius, ulna, and the forearm axis of rotation.
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In most cases, a single compression plate is placed with approximately six cortical screws anchored proximally and distally. Advanced imaging is not usually indicated on initial assessment. Type I The proximal ulna is fractured and radial head dislocation directed anteriorly. Formal physiotherapy is rarely needed in the pediatric mobteggia, but elbow range of motion may take several months for complete recovery.