Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 27 2021

Monteggia Fracture

  • 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. On examination, the affected arm is swollen and tender around his elbow. Radiographs demonstrate a displaced fracture of the proximal ulnar diaphysis and radial head dislocation.
  • Introduction
    • Clinical definition
      • traumatic injury to the elbow and forearm characterized by the presence of two bony injuries
        • diaphyseal fracture of the proximal third of the ulna
        • radial head dislocation
  • Prognosis
    • Unfavorable
      • delayed diagnosis
        • radial head dislocation can be missed on initial radiographs
  • Epidemiology
    • Incidence
      • less common than other types of serious elbow injuries in children (e.g., supracondylar fracture, radial head subluxation, and lateral condylar fracture)
    • Demographics
      • more common in children than adults
        • peak age range 4-10 years of age
  • Etiology
    • Traumatic injury
      • Fall On an OutStretched Hand (FOOSH)
      • direct blow to the ulna
    • Pathoanatomy
      • normal anatomy of the elbow and forearm
        • forearm consists of 2 bones
          • radius
          • ulna
        • elbow consists of 3 joints
          • radiocapitellar joint
          • ulnohumeral joint
          • proximal radioulnar joint
      • fracture mechanics
        • fall on an outstretched hand or traumatic blow leads to proximal ulnar diaphyseal fracture and radial head dislocation
        • annular ligament may become interposed in the radiocapitellar joint, preventing reduction of the dislocated radial head
    • Associated conditions
      • may occur with other traumatic injuries to the elbow and forearm
        • distal radius fracture
        • olecranon fracture
        • radial head fracture
        • coronoid process fracture
  • Presentation
    • Symptoms
      • elbow pain and swelling
    • Physical exam
      • tenderness to palpation along the elbow
      • decreased elbow range of motion due to pain
      • radial head may be palpable if significantly dislocated
  • Imaging
    • Radiographs
      • indication
        • radiographs are indicated if there is any suspicion for fracture
      • finding
        • proximal ulnar shaft fracture with radial head dislocation
          • ulna fracture will be easily visible in most cases
          • radial head dislocation can be missed
  • Differential
    • Galeazzi fracture
      • distinguishing factors
        • radiographs will show radial diaphyseal fracture and distal radioulnar joint dislocation
        • patient generally will have pain localized to the wrist instead of the elbow
    • Supracondylar fracture
      • distinguishing factors
        • radiographs will demonstrate evidence of fracture (e.g., fracture line or enlarged fat pads) along the supracondylar humerus without evidence of radial head dislocation
  • Treatment
    • Conservative
      • closed reduction +/- intramedullary fixation and casting
        • indication
          • used in some fractures in children
    • Operative
      • open reduction and internal fixation (ORIF)
        • indication
          • used in all adult fractures and more severe pediatric fractures
  • Complications
    • Posterior interosseous nerve (PIN) palsy
      • generally, a neuropraxia caused by anterior displacement of the radial head
      • spontaneous recovery is expected
1 of 0
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options