All Monteggia fracture-dislocations require an urgent orthopedic assessment. Reduction is always required. Delayed or missed diagnosis is the most frequent. Monteggia fractures account for approximately 1% to 2% of all forearm fractures. Distal forearm fractures are far more frequent than midshaft. Monteggia fracture-dislocations consist of a fracture of the ulnar shaft with concomitant dislocation of the radial head. The ulnar fracture is usually obvious.
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Please vote below and help us build the most advanced adaptive learning platform in medicine. The two limbs may be passed through drill holes from the coronoid fracture bed to the dorsal side of the ulna and tied at the end of the procedure.
The patient should be positioned supine with the arm draped over a pillow on the montegbia. Pediatric Radial head dislocation?
L7 – years in practice. Type I The proximal ulna is fractured and radial head dislocation directed anteriorly.
Evaluation and Management of Monteggia Fractures
These fractures are a less common injury compared to forearm fractures. Educational video describing the classification of monteggia fractures. Most pediatric Monteggia fractures can be treated via closed means. These are the most common fracturs types in adults, particularly the elderly. For those that require operative treatment, what is typically required is fixation that allows maintenance of angular stability.
Ulnar nerve injuries are rare. If an ulna fracture is present, always look for a radial head dislocation. Notice that the ulna border is not straight shaded area. Osteoporosis must be taken into account when treating adult fractures.
An extended midline posterior approach will allow access to all structures. Rahij Anwar, Kenneth W. Large C-arm allows easier imaging than the mini C-arm, and provides a view of a greater proportion of the forearm, which can be helpful in judging ulnar deformity.
In children, the results of early treatment are always good, typically normal or nearly so. It should be straight, not bowed. Nerve injuries can occur from a laceration or entrapment, with radial and median nerve injuries being the most common.
What is the most likely diagnosis? A Monteggia fracture-dislocation refers to dislocation of the radial head proximal radioulnar joint with fracture of the ulna. Support Radiopaedia and see fewer ads.
Monteggia Fractures – Trauma – Orthobullets
A type 1 coronoid fracture may be captured with a 2 non-absorbable suture through the adjacent capsule. Difficulty in management and outcomes increases with Babo type 2 fractures and when associated with other comorbid fractures radial head and coronoid process fractures.
When there is no stable fragment attached to the radial neck to build to, a precontoured plate may be used fix the head fragment to the shaft. His radiographs are shown in figures A and B. Because Monteggia fractures all involve disruption of the radiocapitellar joint, these injuries all require some form of intervention.
HPI – Fell from facture height. D ICD – The alignment and stability of the radius and ulna originate from three ligamentous structures: The ulnar fracture is usually obvious, whereas the radial head dislocation can be overlooked, with potentially serious functional and medico-legal ramifications.
Athletes and manual workers may require more prolonged rehabilitation. What advice fractufe I give to parents? Plain X-rays are usually sufficient, but CT can be of value in preoperative planning.
Even larger fractures, or medial coronoid fragments that would benefit from buttressing, may be reduced and plated via an FCU splitting approach. Successful Strategies for Managing Monteggia Injuries.