The mechanism of injury is most often a fall on an outstretched hand. (6/78), Undecided Surgical Management of Missed Pediatric Monteggia Fractures: A Systematic Review and Meta-Analysis. 3rd ed. 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 1998 Sep;27(9):606-9. - See: Pathology of the annular ligament in paediatric Monteggia fractures. 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 investigators evaluated outcomes on the basis of the 100-point MEPI, radiology, and questionnaire. Bado type I lesion. The keys to successful diagnosis of a Monteggia fracture are clinical suspicion and radiographs of the entire forearm and elbow. Monteggia Fracture | Pediatric Orthopaedic Society of North - POSNA 1982 Jul. Material and method On examination, the affected arm is swollen and tender around his elbow. - ulnar frx is treated w/ compression plate (esp in proximal third) (0/7), Level 3 - Giovanni Monteggia (1814) first described frx of proximal 1/3 of ulna in association w/ 2013 Jan;44(1):59-66. - type I, III, and IV lesions are held in 110 deg. Acute pediatric Monteggia fractures: A. conservative approach to stabilization. (0/1), Level 3 constantpressure exerted by the dislocated radial head; 2016 Jun. 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. [14]. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Undecided Tan L, Li YH, Sun DH, Zhu D, Ning SY. A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. A review of the complications, Does a Monteggia variant lesion result in a poor functional outcome? J Pediatr Orthop. HTML view of the file Chapter 10.html Some injuries associated with radiocapitellar dislocation (such as the transolecranon fracture-dislocation of the elbow) are mislabeled as Monteggia lesions, when in fact the PRUJ remains intact. Hand (N Y). The Monteggia fracture is relatively rare. Undecided This is the most common type of Monteggia fracture. - attempt to palpate radial head (ant, post, or lateral); The treating physician may reduce an unrecognized dislocation while reducing or immobilizing the ulna fracture. Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children. Adults and unstable injuries generally require ORIF of the ulna. The radial head dislocation may not be apparent and will possibly be missed if the elbow is not included in the radiograph. A 45-year-old male falls off his motorcycle and injures his arm. The eponymous term "Monteggia fracture" is most precisely used to refer to dislocation of the proximal radioulnar joint in association with a forearm fracture. - this is esp true on the lateral projection; Int J Clin Exp Med. Lateral ulnar collateral ligament disruption, Anterior band of the medial collateral disruption, Posterior band of the medial collateral ligament disruption. anteriorangulation (usually proximal third); 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. Complex Monteggia Fractures in the Adult Cohort: Injury and Management. [QxMD MEDLINE Link]. 1949;31B:578-88. Please confirm that you would like to log out of Medscape. 2023 Lineage Medical, Inc. All rights reserved. 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. [QxMD MEDLINE Link]. - apex of angular deformity of ulna usually indicates direction of radial head dislocation; - Reduction: Speed JS, Boyd HB: Treatment of fractures of ulna with dislocation of head ofradius (Monteggia fracture). Richard L Ursone, MD Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, Brooke Army Medical Center Monteggia's Fracture : Wheeless' Textbook of Orthopaedics [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%). Are you sure you want to trigger topic in your Anconeus AI algorithm? Di Gennaro GL, Martinelli A, Bettuzzi C, Antonioli D, Rotini R. Outcomes after surgical treatment of missed Monteggia fractures in children. Cast treatment with the elbow extended. [QxMD MEDLINE Link]. - immobilize forearm in neutral rotation w/ slight supination, w/ cast carefully molded over lateral side of ulna at level of fracture; 2023 Lineage Medical, Inc. All rights reserved. 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. - lateral or anterolateral dislocation of the radial head; Ramski, D., Hennrikus, W., Bae, D., et. 2008 Apr. - reduction: [13] : Pain, nerve dysfunction, and cosmetic deformity are other factors to consider in evaluating the outcome of treatment in Monteggia fracture-dislocations. 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. (0/1), Level 1 Monteggia fracture - Wikipedia J Pedtiatr Orthop 2016; 35:S67-S70. - Type III - 20% The relatively good results associated with nonoperative treatment of pediatric Monteggia injuries reflect the prevalence of stable (incomplete) fractures in children. [QxMD MEDLINE Link]. (0/1). Monteggia Fractures: Pearls and Pitfalls - ScienceDirect Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). The character of the ulnar fracture is useful in determining optimal treatment. PDF Case Report The MonteggiaFracture: literature review and report of a Advances in radiography and fracture research have helped define, classify, and guide operative management. - line drawn thru radial shaft and radial head should align w/ capitellum in any position if the radial head is in normal position The mean Broberg and Morrey score increased from 89 points to 94 points, and the median Disabilities of the Arm, Shoulder, and Hand (DASH)score was 7 points at long-term follow-up. - bony ankylosis may be more disabling than the joint instability Monteggia fractures account for fewer than 5% of forearm fractures, with published literature supporting figures in the range of 1-2%. The results of the present series are much better than those reported in most earlier studies, suggesting that stable anatomical fixation of the ulnar fracture (including associated fracture fragments of the coronoid process) with a plate and screws inserted with use of current techniques of fixation leads to a satisfactory result in most adults who have a Monteggia fracture. Diagnosis can be made with plain radiographs of the elbow. Monteggia Fracture - Pediatric - Pediatrics - Orthobullets Rockwood CA, Green DP, Bucholz R, eds. Surgical Management of Complex Adult Monteggia Fractures. 2009 Nov. 34 (9):1618-24. Datta T, Chatterjee N, Pal AK, Das SK. Foran, I., Upasani, V., Wallace, C., et.al. According to the classification of Bado, there were seven type-I, thirty-eight type-II, one type-III, and two type-IV injuries. The key to a good outcome after a Monteggia-type fracture-dislocation of the forearm remains early recognition of proximal radioulnar dissociation. Conclusions: Monteggia fracture dislocation equiva-lents are rare injuries and pre-surgery recognition by radio-graphs and 3-D CT helps make optimal plan. 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. Beutel BG. 28 (19):e839-e848. - non union of frx of ulnar shaft The posterior interosseous nerve travels around the neck of the radius and dives under the supinator as it courses into the forearm. (1/1), Level 4 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. Subluxation of the radial head occurred in three patients; one patient experienced transient palsy of the posterior interosseous nerve; and distortion of the radial head (which had no bearing on function) occurred in three. Dhoju D, Parajuli B. Functional Outcome of Pediatric Monteggia Fracture Dislocation Treated Surgically in a Tertiary Care Centre of Nepal. Monteggia fractures are one third as common as the more . [Full Text]. Surgical Treatment of Neglected Adult Monteggia Fracture - ResearchGate [QxMD MEDLINE Link]. Kopriva J, Awowale J, Whiting P, Livermore A, Siy A, Hetzel S, et al. 3rd ed. - recurrent radial head dislocation - hence, these patients will require close follow up; - Treatment: 2014 Jun. [3]. Monteggia GB. 35 (3):e434-7. - r/o tear of the annular ligament Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. 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. Reckling FW. [QxMD MEDLINE Link]. Bae DS. 1951 Feb. 33-B (1):65-73. and radial deviation of head; - Complications: (2/7), Level 4 [2 . 1949 Nov. 31B (4):578-88, illust. Are you sure you want to trigger topic in your Anconeus AI algorithm? [9] and Penrose in 1951 Murali Poduval, MBBS, MS, DNB Orthopaedic Surgeon, Senior Consultant, and Subject Matter Expert, Tata Consultancy Services, Mumbai, India Most nerve injuries are neurapraxias and typically resolve over a period of 4-6 months. 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]. - Mechanism: [QxMD MEDLINE Link]. Bado believed that the type III lesion, the result of a direct lateral force on the elbow, was primarily observed in children. Hand Clin. Surgical treatment of Monteggia variant fracture dislocations of the This principle also applies to aGaleazzi fracture, which is a fracture of the distal radius with concomitant dislocation of the distal radioulnar joint (DRUJ). Galezzi's fracture-fracture to the distal radius accompanied by ulnar head dislocation at distal radio-ulna joint. Xiao RC, Chan JJ, Cirino CM, Kim JM. 4 (2):167-72. Which direction is the radial head most likely dislocated? A Monteggia fracture-dislocation, or proximal ulnar fracture with associated radial head dislocation, is a complex injury of the forearm and elbow that can destabilize the elbow leading to poor functional outcomes. (0/7), Level 2 [QxMD MEDLINE Link]. 7th ed. In essence, high-energy trauma (eg, a motor vehicle collision) and low-energy trauma (eg, a fall from a standing position) can result in the described injuries. [QxMD MEDLINE Link]. 2013. We present an unreported configuration of a traumatic olecranon fracture with a concomitant medial radial head dislocation in a 3-year-old male.. The fracture of the radial head was treated with either complete or partial excision of the fragments in twelve patients (with replacement with a silicone prosthesis in two), open reduction and internal fixation in ten patients, and no intervention in four patients. Clin Orthop Relat Res. 2012 Jun. It is imperative to look for associated injuries of the radial head and coronoid, which alter the management and lead to altered outcomes. A 12-year-old male sustains an ulnar fracture with an associated posterior-lateral radial head dislocation. What are Monteggia fractures and how are they classified and treated? (OBQ09.264) This may occur in the field spontaneously or as a result of manipulation by emergency responders. When the ulna is fractured, energy is transmitted along the interosseous membrane, displacing the proximal radius. Data Trace Publishing Company Bruce HE, Harvey JP, Wilson JC Jr. Monteggia fractures. Tan SHS, Low JY, Chen H, Tan JYH, Lim AKS, Hui JH. Prompt recognition of this injury is imperative. These ligaments stretch or rupture during radial head dislocation. 2020 Mar. [1], The first challenge is correctly assessing the extent and nature of the injury. - posterior Monteggia frx is reduced by applying traction to forearm w/ the forearm in full extension; (0/8), Level 1 Are you sure you want to trigger topic in your Anconeus AI algorithm? - realize that even w/ successful closed reduction of the ulna (and accompanying reduction of the radial head) that subsequently [QxMD MEDLINE Link]. J Bone Joint Surg Br. - ref: Repair of Bado II Monteggia Fracture: Case Presentation and Surgical Technique. Few contraindications for surgery exist. Are you sure you want to trigger topic in your Anconeus AI algorithm? 2009 Jun. [8] : The Bado classification is based on the recognition that the apex of the fracture is in the same direction as the radial head dislocation. J Am Acad Orthop Surg. Gemeinsam ist diesen 3 Formen die Kombination der Fraktur. - Monteggia Fractures in Children. Acta Orthop Belg. You are being redirected to 2023 Lineage Medical, Inc. All rights reserved. Monteggia Fracture - an overview | ScienceDirect Topics Kombinationsverletzungen des Unterarms werden nach ihrer Lokalisation als Galeazzi-, Monteggia- oder Essex-Lopresti-Lsionen bezeichnet. [QxMD MEDLINE Link]. Nine patients, all of whom had a Bado type-II fracture, needed a reoperation within three months after the initial operation; five had revision of a loose ulnar fixation device, three had resection of the radial head, and one had removal of a wire that had migrated from the radial head into the elbow articulation. Undecided 1974 Dec. 56 (8):1563-76. - radial head is gently repositioned by direct manual pressure anteriorly on the bone; (5/8), Level 4 Purpose: Monteggia variant defined as Monteggia fracture dislocation with radial head or neck fracture, coronoid fracture, ulnohumeral joint dislocation or combination of these injuries. In a study evaluating long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in 22 children (14 boys, 8 girls; age range, 4 y to 15 y 11 mo), Nakamura et al noted that the postoperative Mayo Elbow Performance Index (MEPI) at follow-up ranged from 65 to 100, with 19 excellent results, two good results, one fair result, and zero poor results. : A retrospective study, Mortons Neuroma: Interdigital Perineural Fibrosis, Orthopaedic Specialists of North Carolina. Pediatric Monteggia fractures: amulticenter examination of treatment strategy and early clinical and radiographic results. Children (Basel). Forty-eight patients who had been followed for a minimum of two years (average, 6.5 years; range, two to fourteen years) were identified. Orthopedics. [QxMD MEDLINE Link]. encoded search term (Monteggia Fracture) and Monteggia Fracture. Does a Monteggia variant lesion result in a poor functional outcome? Philadelphia: Lippincott Williams & Wilkins; 2012: 351-65. - radioulnar synostosis - dislocation of radial head may be missed, eventhough frx of ulna is obvious (need AP, lateral and olbique X-rays of elbow) 2021 Nov. 46 (11):1006-1015. Radiographically, there were 15 good results, seven fair results, and zero poor results. Adults and unstable injuries generally require ORIF of the ulna. A high index of suspicion, therefore, should be maintained with any ulna fracture. Once the cast is hardened, mark it, then split using an oscillating saw, a hand saw, or a sharp plaster knife (1). Hume fracture - fracture of the olecranon accompanied by anterior dislocation of the radial head. - immobilization is continued until there is union of the ulna; 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. The distal ulna and radius also articulate at the DRUJ. (3/76), Level 1 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.
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