Monteggia fracture-dislocations remain a relatively uncommon injury. [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. Forty-eight patients who had been followed for a minimum of two years (average, 6.5 years; range, two to fourteen years) were identified. The distal ulna and radius also articulate at the DRUJ. The result was excellent for eighteen patients, good for twenty-two, fair for two, and poor for six. 2013. Monteggia fractures in adults: long-term results and prognostic factors. - 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). Findings associated with the concomitant radial head dislocation are often subtle and can be overlooked. A 12-year-old male sustains an ulnar fracture with an associated posterior-lateral radial head dislocation. 1982 Jul. The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius. Hand (N Y). 110 West Rd., Suite 227 Lateral ulnar collateral ligament disruption, Anterior band of the medial collateral disruption, Posterior band of the medial collateral ligament disruption. - when dx is delayed < 3 months, ORIF is indicated; - anterior dislocation of the radial head; The notoriously poor results of treatment of Monteggia fractures in adults improved dramatically after the development of modern techniques of plate-and-screw fixation, which facilitate early mobilization by ensuring anatomic reduction. Pronation injuries of the forearm, with special reference to theanterior Monteggia fracture. Forearm fractures in children. Xiao RC, Chan JJ, Cirino CM, Kim JM. (10/80), Level 3 Prompt recognition of this injury is imperative. What are floating elbow injuries and how are they treated? Are you sure you want to trigger topic in your Anconeus AI algorithm? (20/80). Undecided [QxMD MEDLINE Link]. 91 (6):1394-404. Vol 2: 520. The posterior interosseous nerve travels around the neck of the radius and dives under the supinator as it courses into the forearm. 2023 Lineage Medical, Inc. All rights reserved. (1/7), Level 1 2022 Jul 22. 2020 Mar. [5] The mean arc of forearm rotation increased from 145 to 149. 4 (2):167-72. With careful definition, specific subsets of patients may benefit from consideration as a separate type of Monteggia injury. [14]. J Pediatr Orthop 2017: 37(6): e335-e341.Penrose JH. [5] The ulna provides a stable platform for rotation of the radius and forearm. Adult Monteggia and Olecranon Fracture Dislocations of the Elbow. Philadelphia: JB Lippincott; 1991. 1949 Nov. 31B (4):578-88, illust. - frx of ulna just distal to coronoid process w/ lateral dislocation of radial head; - Type IV (5%) This may occur in the field spontaneously or as a result of manipulation by emergency responders. - this is esp true on the lateral projection; The end result is a disrupted interosseous membrane proximal to the fracture, a dislocated PRUJ, and a dislocated radiocapitellar joint. [QxMD MEDLINE Link]. Monteggia fracture-dislocations remain a relatively uncommon injury. - angulated ulnar shaft is reduced by firm manual pressure; - Type II (flexion type) - 15% - PIN or radial nerve palsy from anterior displacement of radial head; [1] [2] Causes Mechanisms include: Fall outstretched hand with the forearm in excessive pronation (hyper-pronation injury). Compartment Syndrome in Operatively Managed Pediatric Monteggia Fractures and Equivalents. - keep elbow flexed ( > 90 deg), to relax biceps, so that full supination can be avoided w/o losing reduction; - Non Operative Treatment: This injury is frequently confused with anterior Monteggia lesions by virtue of the readily apparen 28 (19):e839-e848. Treatment can be isolated closed reduction in the pediatric population (if radiocapitellar joint remains stable). Orthop Traumatol Surg Res. - radial head is gently repositioned by direct manual pressure anteriorly on the bone; These unsatisfactory results were related to a malunited fracture of the coronoid process in two patients, a proximal radioulnar synostosis in one, a malunited fracture of the coronoid process and a proximal radioulnar synostosis in one, a malunion of the ulna in one, and painfully restricted rotation of the forearm after operative fixation of a comminuted fracture of the radial head in one. The keys to successful diagnosis of a Monteggia fracture are clinical suspicion and radiographs of the entire forearm and elbow. Datta et al conducted a prospective, longitudinal study of 21 children with Monteggia fracture with dislocation (18 type I, three type III), all of whom were treated by modified Hirayama corrective osteotomy of the ulna with wedge bone grafting, restoration of bone length, reconstruction of the anular ligament using the Bell Tawse method, and fixation of the radial head with transcapitellar Kirschner wire (K-wire). 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. Material and method The ulna and radius are in direct contact with each other only at the PRUJ and the DRUJ; however, they are unified along their entire length by the interosseous membrane. 1998 Dec;80(12):1733-44. [QxMD MEDLINE Link]. (1/1), Level 4 As multiple variants of Monteggia fractures exist, it is most accurately described as a forearm fracture with dislocation of the proximal radioulnar joint.4 Subtle bowing of the ulna shaft with an asssociated radiocapitellar dislocation may be missed by the inexperienced clinician who is looking for a forearm fracture and therefore Neural injuries are generally traction injuries and result from stretching around the displaced bone or from energy dispersed during the initial injury. Watson-Jones R. Fracture and Joint injuries. 2014 Jun. J Bone Joint Surg Am. The ulna fracture is usually clinically and radiographically apparent. ROM increased by an average of 30. Wong JC, Getz CL, Abboud JA. of flexion for 6 weeks; - Delayed Dx: [QxMD MEDLINE Link]. 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. - anterior dislocation of radial head (or frx) and fracture of ulnar diaphysis at any level w/ The eponym Monteggia fracture is most precisely used to refer to a dislocation of the proximal radioulnar joint (PRUJ) in association with a forearm fracture, most commonly a fracture of the ulna. Fractures in Adults. 1974 Dec. 56 (8):1563-76. of flexion; Monteggia fracture is characterized by radial head dislocation combined with proximal ulnar 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. A review of the complications, Does a Monteggia variant lesion result in a poor functional outcome? (0/1), Level 5 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. [14]. - Monteggia Fractures in Children. 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. (OBQ10.240) head is not promptly reduced; (0/7), Level 3 Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children. Prompt recognition of this injury is imperative. - attempt to palpate radial head (ant, post, or lateral); A good radiographic result was seen in all patients who underwent open reduction within 3 years after injury or before reaching 12 years of age. - Discussion: [QxMD MEDLINE Link]. (0/8), Level 2 Ring D, Jupiter JB, Waters PM. The Monteggia fracture is relatively rare. Twenty-six patients (68 percent) who had a Bado type-II fracture had an associated fracture of the radial head; ten of these patients also had a fracture of the coronoid process as a single large fragment. The Monteggia fracture with posterior dislocation of the radial head. Thank you. 2020 Oct 1. Once the cast is hardened, mark it, then split using an oscillating saw, a hand saw, or a sharp plaster knife (1). Reckling FW. 2016 Jun. Vol 1: Nakamura K, Hirachi K, Uchiyama S, Takahara M, Minami A, Imaeda T, et al. According to the classification of Bado, there were seven type-I, thirty-eight type-II, one type-III, and two type-IV injuries. Instituzioni Chirrugiche. - Giovanni Monteggia (1814) first described frx of proximal 1/3 of ulna in association w/ anterior dislocation of radial head; - hence dislocation of radial head w/ frx of proximal 1/3 of ulna is known as Monteggia's deformity. Towson, MD 21204 2009 Jun. Zivanovic D, Marjanovic Z, Bojovic N, Djordjevic I, Zecevic M, Budic I. Neglected Monteggia Fractures in Children-A Retrospective Study. Properly assessing the nature of this injury in a timely fashion is imperative in order to prevent permanent disability or limb dysfunction. This is a report of two rare variants of Monteggia fracture-dislocation. - achieved w/ forarm in full supination, & longitudinal traction; The radial head dislocation may not be apparent and will possibly be missed if the elbow is not included in the radiograph. In: Beaty JH, Kasser JR,eds. 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. Curr Opin Pediatr. The relatively good results associated with nonoperative treatment of pediatric Monteggia injuries reflect the prevalence of stable (incomplete) fractures in children. 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. Chin J Traumatol. The ulna fracture is usually noted, commonly in the proximal third of the ulna. (1/7), Level 5 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. Di Gennaro GL, Martinelli A, Bettuzzi C, Antonioli D, Rotini R. Outcomes after surgical treatment of missed Monteggia fractures in children. Application of this eponym to all injuries with radiocapitellar subluxation or dislocation has led to some confusion. Dhoju D, Parajuli B. Functional Outcome of Pediatric Monteggia Fracture Dislocation Treated Surgically in a Tertiary Care Centre of Nepal. J Bone Joint Surg Am. Introduction Giovanni Battista Monteggia, a surgical pathologist and public health official in Milan, first described the Monteggia fracture in 1814. 2023 Lineage Medical, Inc. All rights reserved. 64 (6):857-63. The treating physician may reduce an unrecognized dislocation while reducing or immobilizing the ulna fracture. Successful Strategies for Managing Monteggia Injuries. We present an unreported configuration of a traumatic olecranon fracture with a concomitant medial radial head dislocation in a 3-year-old male.. Wang C, Su Y. Monteggia fractures and their variants are often misdiagnosed, however, because of the numerous atypical presentations of this injury in children. Stable anatomic reduction of the ulnar fracture results in anatomic reduction of the radial head. constantpressure exerted by the dislocated radial head; - immobilize forearm in neutral rotation w/ slight supination, w/ cast carefully molded over lateral side of ulna at level of fracture;
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