Then divide the underlying padding with scissors (2) and remove the protective strip to expose the skin. Is Bone Mineral Density Testing Underused in Prostate Cancer Care? 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, Undecided 2021 Nov. 46 (11):1006-1015. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Closed reduction; cast immobilization for Monteggia lesion - AO Foundation Medscape Education. Chin J Traumatol. - spontaneous recovery is usual & exploration is not indicated; Repair of Bado II Monteggia Fracture: Case Presentation and Surgical Technique. On examination, the affected arm is swollen and tender around his elbow. Musculoskelet Surg. J Bone Joint Surg Am. For patient education resources, see theBreaks, Fractures, and Dislocations Center, as well asBroken Arm,Broken Elbow, andElbow Dislocation. Bae DS. - Discussion: Monteggia fracture - Wikipedia Orthopaedic Specialists of North Carolina. [QxMD MEDLINE Link]. Bado type II lesion after open reduction and internal fixation. Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. 1951;33:65-73. This article describes the diagnosis, treatment, and potential pitfalls encountered in the treatment of Monteggia fractures. Bruce HE, Harvey JP, Wilson JC Jr. Monteggia fractures. [QxMD MEDLINE Link]. (0/7), Level 2 Are you sure you want to trigger topic in your Anconeus AI algorithm? J Clin Diagn Res. Are you sure you want to trigger topic in your Anconeus AI algorithm? Are you sure you want to trigger topic in your Anconeus AI algorithm? Rockwood CA, Green DP, Bucholz R, eds. anteriorangulation (usually proximal third); Since Monteggia first described the fracture bearing his name in 1814, the association of radial head dislocation with ipsilateral ulnar fracture has been well described. Dhoju D, Parajuli B. Functional Outcome of Pediatric Monteggia Fracture Dislocation Treated Surgically in a Tertiary Care Centre of Nepal. These ligaments stretch or rupture during radial head dislocation. We present an unreported configuration of a traumatic olecranon fracture with a concomitant medial radial head dislocation in a 3-year-old male.. Forty-eight patients who had been followed for a minimum of two years (average, 6.5 years; range, two to fourteen years) were identified. Philadelphia: Lippincott Williams & Wilkins; 2012: 351-65. Monteggia's Fracture : Wheeless' Textbook of Orthopaedics [QxMD MEDLINE Link]. 4 (2):167-72. Orthopedics. J Bone Joint Surg Am. The mechanism of injury is most often a fall on an outstretched hand. The result was excellent for eighteen patients, good for twenty-two, fair for two, and poor for six. (1/8), Level 3 2023 Lineage Medical, Inc. All rights reserved. Baltimore: Williams & Wilkins; 1943. 2018 Oct. 102 (Suppl 1):93-102. The treating physician may reduce an unrecognized dislocation while reducing or immobilizing the ulna fracture. - treated by reduction and stabilization of ulna followed by reduction of radial head via supination & direct pressure; Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. Are you sure you want to trigger topic in your Anconeus AI algorithm? Adults and unstable injuries generally require ORIF of the ulna. Copyright 2023 Lineage Medical, Inc. All rights reserved. The distal ulna and radius also articulate at the DRUJ. An ulnar diaphyseal fracture was fixed with an intramedullary Steinmann pin in one patient. Tan JW, Mu MZ, Liao GJ, Li JM. [QxMD MEDLINE Link]. - hence, these patients will require close follow up; - Treatment: PDF Case Report The MonteggiaFracture: literature review and report of a Bennett Fracture - StatPearls - NCBI Bookshelf 2014 Jun. Monteggia Fracture - an overview | ScienceDirect Topics Richard L Ursone, MD Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, Brooke Army Medical Center 1949 Nov. 31B (4):578-88, illust. ORTHOBULLETS; Events. The pediatric Monteggia fracture. - Post - Orthobullets Xiao RC, Chan JJ, Cirino CM, Kim JM. different treatment protocol for children, may be part of complex injury pattern including, Fracture of the proximal or middle third of the ulna with, Fracture of the ulnar metaphysis (distal to coronoid process) with, Fracture of the proximal or middle third of the, Jupiter Classification of Type II Monteggia Fracture-Dislocations, Fracture extending to distal half of ulna, may or may not be obvious dislocation at radiocapitellar joint, may be loss of ROM at elbow due to dislocation, radial deviation of hand with wrist extension, AP and Lateral of elbow, wrist, and forearm, helpful in fractures involving coronoid, olecranon, and radial head, must ensure stabilty and anatomic alignment of ulna fracture, acute fractures which are open or unstable (long oblique), most Monteggia fractures in adults are treated surgically, ORIF of ulna shaft fracture, open reduction of radial head, failure to reduce radial head with ORIF of ulnar shaft only, Monteggia "variants" with associated radial head fracture, lateral decubitus position with arm over padded support, midline posterior incision placed lateral to tip of olecranon, develop interval between flexor carpi ulnaris and anconeus along ulnar border proximally, and interval between FCU and ECU distally, with proper alignment of ulna radial head usually reduces and open reduction of radial head is rarely needed, failure to align ulna will lead to chronic dislocation of radial head, treatment based on involved components (radial head, coronoid, LCL), if no improvement obtain nerve conduction studies, usually caused by failure to obtain anatomic alignment of ulna, If diagnosis is delayed greater than 2-3 weeks complication rates increase significantly, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. [2]. Prompt recognition of this injury is imperative. The remaining patients had fixation with a plate and screws. Stable anatomic reduction of the ulnar fracture results in anatomic reduction of the radial head. Fractures in Adults. Undecided [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%). Data Trace Publishing Company The records concerning ten consecutive years of experience with Monteggia fractures in adult patients at a level-one trauma center were retrospectively reviewed. 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. Floriano Putigna, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic AssociationDisclosure: Nothing to disclose. - key is to obtain length and alignment, which then allows the radial head to be reduced; constantpressure exerted by the dislocated radial head; Anterior elbow dislocations occur most often as a fracture-dislocation in which the distal humerus is driven through the olecranon, thereby causing a complex, comminuted fracture of the proximal ulna. Rang, M., Pring, M. E., & Wenger, D. R. (2005). (8/80), Level 2 Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. J Bone Joint Surg Br. Datta T, Chatterjee N, Pal AK, Das SK. - Giovanni Monteggia (1814) first described frx of proximal 1/3 of ulna in association w/ Pathology of the annular ligament in paediatric Monteggia fractures. Fractures in children. - see: nerve injuries 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. Splinting of the wrist in extension and finger range-of-motion (ROM) exercises help prevent contractures from developing while the patient awaits resolution of the nerve injury. Bado type III lesion with lateral displacement of the radial head. Fractures of the forearm with dislocation of the proximal radioulnar joint are known as Monteggia frac tures26'847. Compartment Syndrome in Operatively Managed Pediatric Monteggia Fractures and Equivalents. [Full Text]. 2020 Oct 1. 2009 Nov. 34 (9):1618-24. 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. - Mechanism: - proposed mechanisms include direct blow & hyperpronation injuries as well- as the hyperextension theory; Murali Poduval, MBBS, MS, DNB is a member of the following medical societies: Association of Medical Consultants of Mumbai, Bombay Orthopedic Society, Indian Orthopedic Association, Indian Society of Hip and Knee SurgeonsDisclosure: Nothing to disclose. - Type III - 20% Treatment can be isolated closed reduction in the pediatric population (if radiocapitellar joint remains stable). [4] The radial head articulates with the humeral capitellum and the radial notch of the proximal ulna. Monteggia Fracture - Orthopedics - Medbullets Step 2/3 [QxMD MEDLINE Link]. Widen the split with a cast spreader. - line drawn thru radial shaft and radial head should align w/ capitellum in any position if the radial head is in normal position [QxMD MEDLINE Link]. In 1991, Anderson and Meyer used the following criteria to evaluate forearm fractures and their prognosis Foran, I., Upasani, V., Wallace, C., et.al. 1951 Feb. 33-B (1):65-73. 2015 Nov. 31 (4):565-80. The Monteggia fracture with posterior dislocation of the radial head. Epub 2012 Oct 10. Forearm fractures in children. 7th ed. Material and method This injury is frequently confused with anterior Monteggia lesions by virtue of the readily apparen 3rd ed. You can rate this topic again in 12 months. anterior dislocation of radial head; J Hand Surg Am. Once the radial head is reduced in closed injuries, surgical treatment may be delayed until the patient is stable and the surgery may be performed in a more elective fashion. Van Tongel A, Ackerman P, Liekens K, Berghs B. Angulated greenstick fractures of the distal forearm in children: closed reduction by pronation or supination. Prompt recognition of this injury is imperative. J Pediatr Orthop. 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). (0/1), Level 2 - associated nerve injury: Epidemiology: Are you sure you want to trigger topic in your Anconeus AI algorithm? [Full Text]. Monteggia Fractures - Trauma - Orthobullets.pdf - Course Hero Waters PM, Bae DS, eds. Monteggia fracture-dislocation is rare in children 2,3,4. [1], The first challenge is correctly assessing the extent and nature of the injury. Monteggia fractures in adults: long-term results and prognostic factors. 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. Most nerve injuries are neurapraxias and typically resolve over a period of 4-6 months. 2012 Jun. Bae, D. Successful strategies for managing Monteggia Injuries. Which direction is the radial head most likely dislocated? 1949;31B:578-88. [15] The average follow-up period was 5.5 years. - non union of frx of ulnar shaft 2018 Feb. 104 (1S):S113-S120. (4/7). (0/1), Level 1 Undecided Orthopedics. Monteggia fractures are primarily associated with falls on an outstretched hand with forced pronation. Separate radiographs should be taken of the elbow. Neglected Monteggia fracture: a review - eor Modified technique for correction of isolated radial head dislocation without apparent ulnar bowing: a retrospective case study. [5] The mean arc of forearm rotation increased from 145 to 149. [Full Text]. The Monteggia lesion is most precisely characterized as a forearm fracture in association with dislocation of the PRUJ. Musculoskelet Surg. 2020 Mar. Neural injuries are generally traction injuries and result from stretching around the displaced bone or from energy dispersed during the initial injury. 1967 Jan-Feb. 50:71-86. 2023 Lineage Medical, Inc. All rights reserved. al. These unsatisfactory results were related to a malunited fracture of the coronoid process in two patients, a proximal radioulnar synostosis in one, a malunited fracture of the coronoid process and a proximal radioulnar synostosis in one, a malunion of the ulna in one, and painfully restricted rotation of the forearm after operative fixation of a comminuted fracture of the radial head in one. of flexion for 6 weeks; - Delayed Dx: Complex Monteggia Fractures in the Adult Cohort: Injury and Management. Wheeless' Textbook of Orthopaedics. 1974 Dec. 56 (8):1563-76. Key words: Monteggia's fracture; Radius fracture; Ulna Galezzi's fracture-fracture to the distal radius accompanied by ulnar head dislocation at distal radio-ulna joint. 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. The key to a good outcome after a Monteggia-type fracture-dislocation of the forearm remains early recognition of proximal radioulnar dissociation. Philadelphia: JB Lippincott; 1991. This eponym is among the most widely recog nized by orthopaedic surgeons, largely because of the notoriously poor results associated with the treatment of these injuries, particularly in adults83948. Towson, MD 21204 Milan: Maspero; 1814. vol 5: Bado JL. [10] studied the etiology of Monteggia fractures on cadavers by stabilizing the humerus in a vise and subjecting different forces to the forearm. Bado JL. Leonidou A, Pagkalos J, Lepetsos P, Antonis K, Flieger I, Tsiridis E, et al. Acta Orthop Belg. A review of the complications, Does a Monteggia variant lesion result in a poor functional outcome? - proposed mechanisms include direct blow & hyperpronation injuries as well-as the HTML view of the file Chapter 10.html Monteggia Fractures in Pediatric and Adult Populations, Clifford R. Wheeless, III, M.D. - this ordinarily requires 6-10 wks depending on the age of pt; The close proximity of these nerves may lead to injuries when a Monteggia fracture occurs. (0/1), Level 3 - this is esp true on the lateral projection; Li H, Cai QX, Shen PQ, Chen T, Zhang ZM, Zhao L. Posterior interosseous nerve entrapment after Monteggia fracture-dislocation in children. J Bone Joint Surg Am. Monteggia Fractures: Pearls and Pitfalls - ScienceDirect https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTIzMTQzOC1vdmVydmlldw==, Type I - Fracture of the proximal or middle third of the ulna with anterior dislocation of the radial head (see the first and second images below), Type II - Fracture of the proximal or middle third of the ulna with posterior dislocation of the radial head (see the third and fourth images below), Type III - Fracture of the ulnar metaphysis with lateral dislocation of the radial head (see the fifth and sixth images below), Type IV - Fracture of the proximal or middle third of the ulna and radius with anterior dislocation of the radial head (see the seventh image below), Excellent - Union with less than 10 loss of elbow and wrist flexion/extension and less than 25% loss of forearm rotation, Satisfactory - Union with less than 20 loss of elbow and wrist flexion/extension and less than 50% loss of forearm rotation, Unsatisfactory - Union with greater than 30 loss of elbow and wrist flexion/extension and greater than 50% loss of forearm rotation, Failure - Malunion, nonunion, or chronic osteomyelitis. 40 (3):e216-e221. Purpose: Monteggia variant defined as Monteggia fracture dislocation with radial head or neck fracture, coronoid fracture, ulnohumeral joint dislocation or combination of these injuries. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. The character of the ulnar fracture is useful in determining optimal treatment. - posterior Monteggia frx is reduced by applying traction to forearm w/ the forearm in full extension; Undecided Surgical management is indicated for radial heads that are not stable following closed reduction. - 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). J Pediatr Orthop. Evaluation of outcome of corrective ulnar osteotomy with bone grafting and annular ligament reconstruction in neglected monteggia fracture dislocation in children. Monteggia fracture-dislocations remain a relatively uncommon injury. Monteggia fracture is characterized by radial head dislocation combined with proximal ulnar fracture.
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