The Monteggia fracture is a

fracture Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displa ...

of the

proximal Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

third of the ulna with dislocation of the proximal head of the radius. It is named after

Giovanni Battista Monteggia Giovanni Battista Monteggia (1762 – 1815) was an Italians, Italian surgeon. The Monteggia fracture is named after him. Biography Early life Giovanni Battista Monteggia was born in Laveno-Mombello, Laveno, near the Lake Maggiore, Lago Maggiore ( ...

Causes

Mechanisms include: * Fall outstretched hand with the forearm in excessive

pronation Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relative ...

(hyper-pronation injury). The ulna fractures in the proximal one-third of the shaft due to extreme dislocation. Depending on the impact and forces applied in each direction, degree of energy absorption determines pattern, involvement of the radial head and whether or not open soft tissue occurs. * Direct blow on back of upper forearm would be a very uncommon cause. In this context, isolated ulnar shaft fractures are most commonly seen in defence against blunt trauma (e.g. nightstick injury). Such an isolated ulnar shaft fracture is ''not'' a Monteggia fracture. It is called a 'nightstick fracture'.

Diagnosis

Classification

There are four types (depending upon displacement of the radial head): Bado Classification - Monteggia Fractures

* I - Extension type (60%) - ulna shaft angulates anteriorly (extends) and radial head dislocates anteriorly. * II - Flexion type (15%) - ulna shaft angulates posteriorly (flexes) and radial head dislocates posteriorly. * III - Lateral type (20%) - ulna shaft angulates laterally (bent to outside) and radial head dislocates to the side. * IV - Combined type (5%) - ulna shaft and radial shaft are both fractured and radial head is dislocated, typically anteriorly. These are known as the Bado types.

Management

Monteggia fractures may be managed conservatively in

children A child ( : children) is a human being between the stages of birth and puberty, or between the developmental period of infancy and puberty. The legal definition of ''child'' generally refers to a minor, otherwise known as a person younger ...

with closed reduction (resetting and casting), but due to high risk of displacement causing malunion,

open reduction internal fixation Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone, a concept that dates to the mid-nineteenth century and was made applicable for routine treatment in the m ...

is typically performed. Osteosynthesis (open reduction and internal fixation) of the ulnar shaft is considered the standard of care in adults. It promotes stability of the radial head dislocation and allows very early mobilisation to prevent stiffness. The elbow joint is particularly susceptible to loss of motion.

Prognosis

In children, the results of early treatment are always good, typically normal or nearly so. If diagnosis is delayed, reconstructive surgery is needed and complications are much more common and results poorer. In adults, the healing is slower and results usually not as good. Complications of

ORIF surgery Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone, a concept that dates to the mid-nineteenth century and was made applicable for routine treatment in the m ...

for Monteggia fractures can include non-union, malunion, nerve palsy and damage, muscle damage,

arthritis Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In som ...

tendonitis Tendinopathy, a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder (rotator cuff tendinitis, biceps tendinitis), elbow (tennis elb ...

, infection, stiffness and loss of range of motion, compartment syndrome, audible popping or snapping, deformity, and chronic

pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

associated with surgical hardware such as pins, screws, and plates. Several surgeries may be needed to correct this type of fracture as it is almost always a very complex fracture that requires a skilled orthopedic surgeon, usually a specialist familiar with this type of injury.

References

External links

{{Fractures Bone fractures