Monteggia Fracture - Ulnar Fracture & Radial Head Dislocation
Summary:
- The combination of a radial head dislocation with an ulnar fracture is most commonly known as a Monteggia fracture.
- Though more than one radiographic view should be obtained, it is most commonly seen on an AP radiograph view of the elbow and forearm.
- Get orthopedics involved early, reduce the radial head dislocation and ulnar fracture, and if an open fracture give a tetanus shot, irrigate wound with sterile water, give IV antibiotics, splint and admit to hospital. Failure to treat appropriately can lead to joint instability and inability to supinate and pronate the forearm normally.
Monteggia Fracture
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- Ulnar fracture
- Radial head dislocation, which is most commonly seen on an AP view of the elbow where the radial head is no longer lining up with the capitellum where the radiocapitellar line normally resides.
- Type I = Fracture involves the proximal or middle third of the ulna + radial head dislocation anteriorly
- Type II = Fracture of the proximal or middle third of the ulna + radial head dislocation posteriorly
- Type III = Fracture of the ulnar metaphysis + lateral dislocation of the radial head
- Type IV = Fracture of both the proximal or middle third of the ulna and radius + anterior dislocation of the radial head
- Lateral plain radiograph view
- AP (anterior-posterior) view
- Make sure to evaluate for other associated injuries (as appropriate)
- Provide analgesia as appropriate for age and clinical situation
- Assess neurovascular status of the forearm and hand, if compromised then urgent surgical consult
- Consult orthopedic surgery, especially if an open fracture
- Reduce the fracture and dislocation and apply splint in the emergency department
- If ulnar fracture is open, verify tetanus status and administer if not up to date, reduce fracture under sedation, irrigate the wound with sterile saline, wrap in moist gauze, give parenteral (IV) antibiotics, and admit for surgical management
Basic Features
A Monteggia fracture consists of a combination of both:
Classfication of Monteggia Fractures
There are 4 types of Monteggia fractures (also sometimes called Bado lesion types named after the person who described the types):
Imaging
In patients with suspicion for an orthopedic injury at least 2 plain radiographic views should be obtained to make sure that a dislocation can be determined. The 2 most common radiographic views for an injury to the elbow should include:
Management Considerations
Upon identification of a Monteggia fracture the following should be considered:
Editors: Anthony J. Busti, MD, PharmD, FNLA, FAHA
