The eponymous term "Monteggia fracture" is most precisely used to refer to dislocation of the proximal radioulnar joint in association with a forearm fracture. - recurrent radial head dislocation - radial head is gently repositioned by direct manual pressure anteriorly on the bone; A review of the complications, Does a Monteggia variant lesion result in a poor functional outcome? Philadelphia: Lippincott Williams & Wilkins; 2012: 351-65. J Hand Surg Am. What is the most likely finding? Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Ohio State Medical Association, Ohio Osteopathic Association, American College of Osteopathic Surgeons, American Osteopathic AssociationDisclosure: Received grant/research funds from Tornier for other; Received honoraria from Tornier for speaking and teaching. Monteggia-type elbow fractures in childhood. Pronation injuries of the forearm, with special reference to the anterior Monteggia fracture. [QxMD MEDLINE Link]. - then elbow is gently flexed to > 90 deg to relax biceps; It is imperative to look for associated injuries of the radial head and coronoid, which alter the management and lead to altered outcomes. 2018 Oct. 102 (Suppl 1):93-102. A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. 35 (3):e434-7. and radial deviation of head; - Complications: 2020 Aug. 23 (4):233-237. - when dx is delayed < 3 months, ORIF is indicated; Monteggia fracture-dislocations remain a relatively uncommon injury. [9] and Penrose in 1951 Evaluation of outcome of corrective ulnar osteotomy with bone grafting and annular ligament reconstruction in neglected monteggia fracture dislocation in children. [QxMD MEDLINE Link]. 2015 Nov. 31 (4):565-80. 64 (6):857-63. 2019 Feb. 31 (1):54-60. The character of the ulnar fracture is useful in determining optimal treatment. - attempt to palpate radial head (ant, post, or lateral); Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children. Robert J Nowinski, DO Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio Ulnar fracture with late radial head dislocation: delayed Monteggia fracture. J Bone Joint Surg Am. [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%). Kopriva J, Awowale J, Whiting P, Livermore A, Siy A, Hetzel S, et al. Then divide the underlying padding with scissors (2) and remove the protective strip to expose the skin. Towson, MD 21204 Injury. LIVIN' ON THE MD EDGE: Drive, Chip, and Putt Your Way to Osteoarthritis Relief, Osteoporosis and Osteopenia: Latest Treatment Recommendations, Osteoporosis: A Bare-Bones Guide to Diagnosis and Treatment. These injuries are relatively uncommon, accounting for fewer than 5% of all forearm fractures. 2011 Feb. 77 (1):21-6. Breaks, Fractures, and Dislocations Center, Association of Medical Consultants of Mumbai, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society. 2023 Lineage Medical, Inc. All rights reserved. Are you sure you want to trigger topic in your Anconeus AI algorithm? Delpont M, Louahem D, Cottalorda J. Monteggia injuries. Monteggia fractures account for fewer than 5% of forearm fractures, with published literature supporting figures in the range of 1-2%. Hume fracture - fracture of the olecranon accompanied by anterior dislocation of the radial head. J Pediatr Orthop. Data Trace is the publisher of (4/7). The records concerning ten consecutive years of experience with Monteggia fractures in adult patients at a level-one trauma center were retrospectively reviewed. Adults and unstable injuries generally require ORIF of the ulna. - see: nerve injuries The original description is of a "traumatic lesion distinguished by a fracture of the proximal third of the ulna and an anterior dislocation of the proximal epiphysis of the radius"" [1]. 2. (0/7), Level 3 - See: Monteggia fracture is characterized by radial head dislocation combined with proximal ulnar fracture. J Pediatr Orthop. Pediatric Monteggia fractures: a single-center study of the management of 40 patients. 2009 Jun. - radioulnar synostosis The treating physician may reduce an unrecognized dislocation while reducing or immobilizing the ulna fracture. Treatment can be isolated closed reduction in the pediatric population (if radiocapitellar joint remains stable). Chronic Monteggia. (0/1), Level 1 An Alternative to the Traditional Radiocapitellar Line for Pediatric Forearm Radiograph Assessment in Monteggia Fracture. Widen the split with a cast spreader. 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. - immobilize forearm in neutral rotation w/ slight supination, w/ cast carefully molded over lateral side of ulna at level of fracture; After undergoing closed reduction, the radiocapitellar joint is noted to remain non-concentric. "A Monteggia fracture with apex anterior ulnar shaft fracture is associated with an anterior radial head dislocation. Fractures in children. [QxMD MEDLINE Link]. If the elbow is flexed, the chance of a type II or III lesion is greater. 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. However, this particular fracture pattern only accounts for about 60% of these types of injuries. [QxMD MEDLINE Link]. 1951 Feb. 33-B (1):65-73. Reckling FW. [QxMD MEDLINE Link]. - 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). [QxMD MEDLINE Link]. 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. (1/1), Level 4 Lateral ulnar collateral ligament disruption, Anterior band of the medial collateral disruption, Posterior band of the medial collateral ligament disruption. Are you sure you want to trigger topic in your Anconeus AI algorithm? - r/o tear of the annular ligament Soni JF, Valenza WR, Pavelec AC. Application of this eponym to all injuries with radiocapitellar subluxation or dislocation has led to some confusion. J Bone Joint Surg Am. : A retrospective study, Mortons Neuroma: Interdigital Perineural Fibrosis, Orthopaedic Specialists of North Carolina. - non union of frx of ulnar shaft 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. This article describes the diagnosis, treatment, and potential pitfalls encountered in the treatment of Monteggia fractures. Bado type I lesion. [QxMD MEDLINE Link]. If not diagnosed at an early stage, these lesions can gradually lead to forearm deformities and dysfunction, finally resulting in neglected Monteggia fracture. Wong JC, Getz CL, Abboud JA. 1998 Dec;80(12):1733-44. If you log out, you will be required to enter your username and password the next time you visit. 36 (2):65-73. Monteggia fractures are one third as common as the more . A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. In 1814, Giovanni Battista Monteggia of Milan first described this injury as a fracture to the proximal third of the ulna with associated anterior dislocation of the radial head. (5/8), Level 4 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." [1], The first challenge is correctly assessing the extent and nature of the injury. The ulna fracture is usually noted, commonly in the proximal third of the ulna. Rockwood CA, Green DP, Bucholz R, eds. It is named after Giovanni Battista Monteggia. Monteggia fractures in pediatric and adult populations. Prompt recognition of this injury is imperative. Please confirm that you would like to log out of Medscape. Waters PM, Bae DS, eds. [QxMD MEDLINE Link]. Complex Monteggia Fractures in the Adult Cohort: Injury and Management. [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%). Repair of Bado II Monteggia Fracture: Case Presentation and Surgical Technique. [QxMD MEDLINE Link]. 2022 Feb 1. Which direction is the radial head most likely dislocated? Bado type III lesion with lateral displacement of the radial head. [QxMD MEDLINE Link]. anterior dislocation of radial head; [3]. Philadelphia: JB Lippincott; 1991. 2015. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. - ref: Repair of Bado II Monteggia Fracture: Case Presentation and Surgical Technique. (0/1). Monteggia fracture-dislocation is rare in children 2,3,4. (0/1), Level 1 [5] The mean arc of forearm rotation increased from 145 to 149. 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. - line drawn thru radial shaft and radial head should align w/ capitellum in any position if the radial head is in normal position Epub 2012 Oct 10. Neural injuries are generally traction injuries and result from stretching around the displaced bone or from energy dispersed during the initial injury. A review of the complications. Leonidou A, Pagkalos J, Lepetsos P, Antonis K, Flieger I, Tsiridis E, et al. J Am Acad Orthop Surg. Separate radiographs should be taken of the elbow. The records concerning ten consecutive years of experience with Monteggia fractures in adult patients at a level-one trauma center were retrospectively reviewed. 2023 Lineage Medical, Inc. All rights reserved. Evans EM. - medullary nail in this location may not fill the canal and may thus provide less than rigid fixation; of flexion; AP and lateral radiographs reveal a proximal ulnar shaft fracture, 30 degrees apex anterior, and a radial head dislocation. 39 (4):451-5. 2023 Lineage Medical, Inc. All rights reserved, PediatricsMonteggia Fracture - Pediatric. Acta Orthop Belg. Instituzioni Chirrugiche. Milan: Maspero; 1814. vol 5: Bado JL. (10/80), Level 3 Fractures in Adults. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Orthopedics. Data Trace Publishing Company Undecided Clin Orthop Relat Res. Modified technique for correction of isolated radial head dislocation without apparent ulnar bowing: a retrospective case study. - paralysis of deep branch of radial nerve is most common; - key is to obtain length and alignment, which then allows the radial head to be reduced; [Full Text]. A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. 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. The Monteggia lesion is most precisely characterized as a forearm fracture in association with dislocation of the PRUJ. 2014 Jun. J Am. 110 West Rd., Suite 227 J Pedtiatr Orthop 2016; 35:S67-S70. Six of the eight patients who had an unsatisfactory (fair or poor) result had had a Bado type-II fracture with a concomitant fracture of the radial head. The keys to successful diagnosis of a Monteggia fracture are clinical suspicion and radiographs of the entire forearm and elbow. 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. Wheeless' Textbook of Orthopaedics. [14]. Monteggia fractures in children and adults. [QxMD MEDLINE Link]. J Bone Joint Surg Am. Hand Clin. - achieved w/ forarm in full supination, & longitudinal traction; Epidemiology: head is not promptly reduced; Chin J Traumatol. 2020 Sep. 40 (8):387-395. there may be slow and progressive shortening and angulation; According to the classification of Bado, there were seven type-I, thirty-eight type-II, one type-III, and two type-IV injuries. Pediatric hand and upper limb surgery: a practicalguide. Vol 2: 520. 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.
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