Then divide the underlying padding with scissors (2) and remove the protective strip to expose the skin. Murali Poduval, MBBS, MS, DNB Orthopaedic Surgeon, Senior Consultant, and Subject Matter Expert, Tata Consultancy Services, Mumbai, India In a study evaluating long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in 22 children (14 boys, 8 girls; age range, 4 y to 15 y 11 mo), Nakamura et al noted that the postoperative Mayo Elbow Performance Index (MEPI) at follow-up ranged from 65 to 100, with 19 excellent results, two good results, one fair result, and zero poor results. Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. Philadelphia: Lippincott Williams & Wilkins; 2012: 351-65. The ulna and interosseous membrane also may provide stable platforms for dislocation of the proximal radius, leading to the Monteggia fracture. - angulated ulnar shaft is reduced by firm manual pressure; - Type II (flexion type) - 15% Bado type III lesion with lateral displacement of the radial head. Monteggia fractures and their variants are often misdiagnosed, however, because of the numerous atypical presentations of this injury in children. [QxMD MEDLINE Link]. The posterior interosseous branch of the radial nerve, which courses around the neck of the radius, is especially at risk, particularly in Bado type II injuries. 2022 Jul 22. An Alternative to the Traditional Radiocapitellar Line for Pediatric Forearm Radiograph Assessment in Monteggia Fracture. J Pediatr Orthop. - immobilize forearm in neutral rotation w/ slight supination, w/ cast carefully molded over lateral side of ulna at level of fracture; Are you sure you want to trigger topic in your Anconeus AI algorithm? - 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. Breaks, Fractures, and Dislocations Center, Association of Medical Consultants of Mumbai, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society. The radial head should point towards the capitellum on all radiographs of the elbow. The keys to successful diagnosis of a Monteggia fracture are clinical suspicion and radiographs of the entire forearm and elbow. Injury. - ulnar frx is treated w/ compression plate (esp in proximal third) The remaining patients had fixation with a plate and screws. (1/7), Level 5 Subluxation of the radial head occurred in three patients; one patient experienced transient palsy of the posterior interosseous nerve; and distortion of the radial head (which had no bearing on function) occurred in three. 2020 Aug. 23 (4):233-237. - Type III - 20% A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. Fractures of the shafts of the radius and ulna. Surgical Management of Missed Pediatric Monteggia Fractures: A Systematic Review and Meta-Analysis. - PIN palsy is most common in type I frx and may occur in a delayed fashion if theradial Steven I Rabin, MD, FAAOS Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Musculoskeletal Services, Dreyer Medical Clinic 1998 Dec;80(12):1733-44. - lateral or anterolateral dislocation of the radial head; Orthop Traumatol Surg Res. [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. - hence, these patients will require close follow up; - Treatment: - non union of frx of ulnar shaft - anterior dislocation of radial head (or frx) and fracture of ulnar diaphysis at any level w/ Monteggia fractures in children and adults. The other two unsatisfactory results were in a patient who had had a Bado type-I fracture and in one who had had a Bado type-IV fracture. 2009 Nov. 34 (9):1618-24. If one of the forearm bones is injured, injury should be looked for in the other bone and in associated joints of the forearm, elbow, and wrist. Ramski, D., Hennrikus, W., Bae, D., et. The Monteggia fracture is relatively rare. A 12-year-old male sustains an ulnar fracture with an associated posterior-lateral radial head dislocation. Chin J Traumatol. Pathology of the annular ligament in paediatric Monteggia fractures. Type II lesions that are associated with ulnohumeral dislocation have been noted to have outcome scores with greater disability than those without ulnohumeral dislocation. Delpont M, Louahem D, Cottalorda J. Monteggia injuries. 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. "A Monteggia fracture with apex anterior ulnar shaft fracture is associated with an anterior radial head dislocation. Van Tongel A, Ackerman P, Liekens K, Berghs B. Angulated greenstick fractures of the distal forearm in children: closed reduction by pronation or supination. J Pediatr Orthop 2015; 35 (2) 115-120. Monteggia fracture-dislocations remain a relatively uncommon injury. [Full Text]. (5/8), Level 4 A review of the complications. Are you sure you want to trigger topic in your Anconeus AI algorithm? The mechanism of injury is most often a fall on an outstretched hand. The median and ulnar nerves enter the antecubital fossa just distal to the elbow. 110 West Rd., Suite 227 Richard L Ursone, MD Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, Brooke Army Medical Center [QxMD MEDLINE Link]. Li H, Cai QX, Shen PQ, Chen T, Zhang ZM, Zhao L. Posterior interosseous nerve entrapment after Monteggia fracture-dislocation in children. History Mystery: Did Subdural Hematoma Kill Thomas Aquinas? Bruce HE, Harvey JP, Wilson JC Jr. Monteggia fractures. and radial deviation of head; - Complications: [QxMD MEDLINE Link]. 2011 Feb. 77 (1):21-6. The Orthobullets Podcast In this episode, we review the high-yield topic of Monteggia Fractures from the Trauma section. The Monteggia fracture with posterior dislocation of the radial head. The results of the present series are much better than those reported in most earlier studies, suggesting that stable anatomical fixation of the ulnar fracture (including associated fracture fragments of the coronoid process) with a plate and screws inserted with use of current techniques of fixation leads to a satisfactory result in most adults who have a Monteggia fracture. Monteggia lesions in children and adults: an analysis of etiology and long-term results of treatment, Removal of forearm plates. The mean Broberg and Morrey score increased from 89 points to 94 points, and the median Disabilities of the Arm, Shoulder, and Hand (DASH)score was 7 points at long-term follow-up. Rockwood CA, Green DP, Bucholz R, eds. [QxMD MEDLINE Link]. - spontaneous recovery is usual & exploration is not indicated; 2015. Bado JL. Orthopedics. - radiohumeral ankylosis 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. Prompt recognition of this injury is imperative. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Problems with the elbow related to fractures of the coronoid process and the radial head, which are common with Bado type-II Monteggia fractures, remain the most challenging elements in the treatment of these injuries. Loss of alignment after surgical treatment of posterior Monteggia fractures: salvage with dorsal contoured plating. Monteggia fracture-dislocation in children. Datta T, Chatterjee N, Pal AK, Das SK. 35 (3):e434-7. 2018 Oct. 102 (Suppl 1):93-102. Melvin P. Rosenwasser, MD (CSOT #21, 2016), Frontiers in Upper Extremity Surgery - 2016, Monteggia - Alfred W. Hess, MD (Frontiers #16, 2016), Monteggia Fracture Dislocation - Everything You Need To Know - Dr. Nabil Ebraheim. - bony ankylosis may be more disabling than the joint instability Share cases and questions with Physicians on Medscape consult. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. (26/80), Level 4 J Bone Joint Surg Br. J Hand Surg Am. We present an unreported configuration of a traumatic olecranon fracture with a concomitant medial radial head dislocation in a 3-year-old male.. Guitton TG, Ring D, Kloen P. Long-term evaluation of surgically treated anterior monteggia fractures in skeletally mature patients. Which direction is the radial head most likely dislocated? It is imperative to look for associated injuries of the radial head and coronoid, which alter the management and lead to altered outcomes. - posterior or posterolateral dislocation of radial head (or frx); [11, 12] Of the Monteggia fractures, Bado type I has been reported to be the most common (59%), followed by type III (26%), type II (5%), and type IV (1%). Monteggia fractures and their variants are often misdiagnosed, however, because of the numerous atypical presentations of this injury in children. J Bone Joint Surg Am. Clinical effect of manual reduction of humeroradial joint in the treatment of type - fresh Monteggia fracture in children. (8/80), Level 2 The posterior (Bado type-II) fracture is the most common type of Monteggia fracture in adults. - when dx is delayed < 3 months, ORIF is indicated; Baltimore: Williams & Wilkins; 1943. The Monteggia lesion in children. 2012 Jun. 1949 Nov. 31B (4):578-88, illust. Musculoskelet Surg. - see: nerve injuries - radioulnar synostosis Forearm fractures in children. : A retrospective study, Mortons Neuroma: Interdigital Perineural Fibrosis, Orthopaedic Specialists of North Carolina. Foran, I., Upasani, V., Wallace, C., et.al. The character of the ulnar fracture is useful in determining optimal treatment. (0/1), Level 1 - ref: Repair of Bado II Monteggia Fracture: Case Presentation and Surgical Technique. Canton G, Hoxhaj B, Fattori R, Murena L. Annular ligament reconstruction in chronic Monteggia fracture-dislocations in the adult population: indications and surgical technique. 2014 Jun. Pediatric Monteggia fractures: a single-center study of the management of 40 patients. 9 (8):[QxMD MEDLINE Link]. Monteggia fractures account for fewer than 5% of forearm fractures, with published literature supporting figures in the range of 1-2%. ROM increased by an average of 30. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. (0/1), Level 1 Prompt recognition of this injury is imperative. 28 (19):e839-e848. Take great care to avoid injury to the underlying skin. Penrose considered type II lesions a variation of posterior elbow dislocation. - posterior interosseous nerve may be wrapped around neck of radius, preventing reduction; Treatment can be isolated closed reduction in the pediatric population (if radiocapitellar joint remains stable). Richard L Ursone, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Society of Military Orthopaedic SurgeonsDisclosure: Nothing to disclose. (2/8), Level 5 Conclusions: Monteggia fracture dislocation equiva-lents are rare injuries and pre-surgery recognition by radio-graphs and 3-D CT helps make optimal plan. 2023 Lineage Medical, Inc. All rights reserved. [QxMD MEDLINE Link]. Monteggia Fracture } Drake LeBrun MD Experts 3 Bullets 65 3.4 ( 5 ) 3 Images Snapshot A 35-year-old man presents to the emergency room for severe right elbow and forearm pain after sustaining a blunt injury to his right arm. Cast treatment with the elbow extended. The end result is a disrupted interosseous membrane proximal to the fracture, a dislocated PRUJ, and a dislocated radiocapitellar joint. After undergoing closed reduction, the radiocapitellar joint is noted to remain non-concentric. 2023 Lineage Medical, Inc. All rights reserved. Type in at least one full word to see suggestions list, 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. You can rate this topic again in 12 months. - Monteggia Fractures in Children. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. The Galeazzi fracture is a fracture of the middle to distal one-third of the radius associated with dislocation or subluxation of the distal radioulnar joint (DRUJ). (OBQ09.264) In his classic 1943 text, Watson-Jones stated that "no fracture presents so many problems; no injury is beset with greater difficulty; no treatment is characterized by more general failure." The Monteggia lesion is most precisely characterized as a forearm fracture in association with dislocation of the PRUJ.
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