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Monteggia's Fracture
Aka: Monteggia's Fracture, Monteggia's Dislocation, Monteggia Fracture, Monteggia Fracture Dislocation
- See Also
- Forearm Fracture (GRUM Mnemonic)
- Galeazzi Fracture
- Definitions
- Monteggia Fracture
- Proximal ulna Fracture AND Radial Head Dislocation
- Mechanism
- Fall on Outstretched Hand WITH
- Extended elbow AND Hyperpronated Forearm
- Signs
- Decreased elbow range of motion
- Proximal third ulna tenderness, swelling, deformity suggesting Fracture of shaft (typically displaced)
- Proximal Radial Head Dislocation
- Perform a careful Hand Neurovascular Exam
- Risk of Radial Nerve injury (including posterior interosseous nerve which branches from Radial Nerve)
- Evaluate extension of thumb, wrist and MCP joint
- Types: Bado Classification
- Type 1: Extension (60-70% of Fractures, esp. children)
- Radial head dislocates anteriorly
- Type 2: Flexion (15% of Fractures, esp. adults)
- Radial head dislocates posteriorly or posterior-laterally
- Type 3: Lateral (20% of Fractures)
- Radial head dislocates laterally or anterior-laterally
- Type 4: Combined (1% of Fractures)
- Radial head dislocates anteriorly AND
- Radial Fracture (in addition to the proximal ulna Fracture)
- Differential Diagnosis
- See Forearm Fracture (GRUM Mnemonic)
- See Radial Head Dislocation
- Galeazzi Fracture
- Elbow Dislocation
- Imaging: Forearm XRay
- Ulna Fracture may not be obvious (greenstick Fracture)
- Radial Head Dislocation may be overlooked
- Xray joint above and below Forearm (standard protocol)
- Wrist XRay
- Elbow XRay
- Management
- Acute Management
- Closed reduction AND Long Arm Splint immobilization for stable, non-displaced Fractures
- Emergent orthopedic consult for displaced Monteggia Fracture Dislocations (unstable)
- Follow-up with orthopedic surgery
- Child: Closed reduction may suffice
- Adult: Open reduction and internal fixation (ORIF)
- References
- Hartman, Morrissey and Kiel (2020) Crit Dec Emerg Med 34(1): 16-17