II. Definitions

  1. Monteggia Fracture
    1. Proximal Ulna Fracture AND Radial Head Dislocation

III. Mechanism

  1. Fall on Outstretched Hand WITH
  2. Extended elbow AND Hyperpronated Forearm

IV. Signs

  1. Decreased elbow range of motion
  2. Proximal third ulna tenderness, swelling, deformity suggesting Fracture of shaft (typically displaced)
  3. Proximal Radial Head Dislocation
    1. Perform a careful Hand Neurovascular Exam
    2. Risk of Radial Nerve injury (including posterior interosseous nerve which branches from Radial Nerve)
    3. Evaluate extension of thumb, wrist and MCP joint

V. Types: Bado Classification

  1. Type 1: Extension (60-70% of Fractures, esp. children)
    1. Radial head dislocates anteriorly
  2. Type 2: Flexion (15% of Fractures, esp. adults)
    1. Radial head dislocates posteriorly or posterior-laterally
  3. Type 3: Lateral (20% of Fractures)
    1. Radial head dislocates laterally or anterior-laterally
  4. Type 4: Combined (1% of Fractures)
    1. Radial head dislocates anteriorly AND
    2. Radial Fracture (in addition to the proximal Ulna Fracture)

VII. Imaging: Forearm XRay

  1. Ulna Fracture may not be obvious (greenstick Fracture)
  2. Radial Head Dislocation may be overlooked
  3. Xray joint above and below Forearm (standard protocol)
    1. Wrist XRay
    2. Elbow XRay

VIII. Management

  1. Acute Management
    1. Closed reduction AND Long Arm Splint immobilization for stable, non-displaced Fractures
    2. Emergent orthopedic consult for displaced Monteggia Fracture Dislocations (unstable)
  2. Follow-up with orthopedic surgery
    1. Child: Closed reduction may suffice
    2. Adult: Open reduction and internal fixation (ORIF)

IX. References

  1. Hartman, Morrissey and Kiel (2020) Crit Dec Emerg Med 34(1): 16-17

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Related Studies

Ontology: Monteggia's Fracture (C0026508)

Definition (MSH) Fracture in the proximal half of the shaft of the ulna, with dislocation of the head of the radius.
Concepts Injury or Poisoning (T037)
MSH D009011
SnomedCT 123973009, 90723006
English Monteggia Fracture, Monteggia's Fracture, Monteggias Fracture, Fracture, Monteggia's, Monteggia's dislocation, Monteggia fracture, Monteggia's Fracture [Disease/Finding], monteggia fracture, monteggia's fracture, Monteggia's dislocation (disorder), Monteggia's fracture, Monteggia fracture dislocation, Monteggia's fracture (disorder), Monteggia; fracture, fracture; Monteggia
Swedish Monteggias fraktur
Czech Monteggiova fraktura
Finnish Monteggian murtuma
Spanish fractura luxación de Monteggia, luxación de Monteggia, luxación de Monteggia (trastorno), fractura de Monteggia (trastorno), fractura de Monteggia, Fractura de Monteggia
Polish Złamanie Monteggia
Norwegian Monteggias fraktur, Monteggias brudd
Dutch Monteggia; fractuur, fractuur; Monteggia, Fractuur, monteggia-, Monteggiafractuur
French Fracture de Monteggia, Fracture de l'avant-bras de Monteggia, Fracture-luxation de l'avant-bras de Monteggia
German Monteggia-Fraktur
Italian Frattura di Monteggia
Portuguese Fratura de Monteggia