The eponymous term "Monteggia fracture" is most precisely used to refer to dislocation of the proximal radioulnar joint in association with a forearm fracture. Acta Orthop Belg. [QxMD MEDLINE Link]. The pediatric Monteggia fracture. - Post - Orthobullets 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. A Monteggia fracture involves a fracture of the ulna with disruption of the proximal radio-ulnar joint (PRUJ) and radiocapitellar dislocation (Bado, 1967). The ulna fracture is usually noted, commonly in the proximal third of the ulna. J Bone Joint Surg Br. Which direction is the radial head most likely dislocated? Prompt recognition of this injury is imperative. 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. - proposed mechanisms include direct blow & hyperpronation injuries as well-as the National Center for Biotechnology Information Monteggia fracture-dislocations in children. [10] studied the etiology of Monteggia fractures on cadavers by stabilizing the humerus in a vise and subjecting different forces to the forearm. - posterior or posterolateral dislocation of radial head (or frx); Then divide the underlying padding with scissors (2) and remove the protective strip to expose the skin. 2008 Apr. What preoperative planning is required for surgical treatment of. Steven I Rabin, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Fracture Association, American Orthopaedic Association, AO Foundation, Chicago Metropolitan Trauma Society, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society, Mid-America Orthopaedic Association, Orthopaedic Trauma AssociationDisclosure: Nothing to disclose. Waters PM. The end result is a disrupted interosseous membrane proximal to the fracture, a dislocated PRUJ, and a dislocated radiocapitellar joint. With careful definition, specific subsets of patients may benefit from consideration as a separate type of Monteggia injury. - angulated ulnar shaft is reduced by firm manual pressure; - Type II (flexion type) - 15% This injury is frequently confused with anterior Monteggia lesions by virtue of the readily apparen Galeazzi fracture: Distal radial shaft fracture with associated distal radio-ulnar joint (DRUJ) dislocation Special Investigations Imaging '2 views and 2 joints': Always get a minimum of two views (AP and LAT) that include the joint above and below the injury (two joints). 2023 Lineage Medical, Inc. All rights reserved. [QxMD MEDLINE Link]. (8/80), Level 2 [3]. [QxMD MEDLINE Link]. - PIN or radial nerve palsy from anterior displacement of radial head; 1974 Dec. 56 (8):1563-76. - bony ankylosis may be more disabling than the joint instability 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. 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. J Bone Joint Surg Br. Telephone: 410.494.4994. [QxMD MEDLINE Link]. Stitgen A, McCarthy JJ, Nemeth BA, Garrels K, Noonan KJ. Monteggia fractures in children and adults. The close proximity of these nerves may lead to injuries when a Monteggia fracture occurs. Problems with the elbow related to fractures of the coronoid process and the radial head, which are common with Bado type-II Monteggia fractures, remain the most challenging elements in the treatment of these injuries. Kevin Strohmeyer, MD Consulting Surgeon, Department of Orthopedic Surgery, Darnall Army Community Hospital, Kevin Strohmeyer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons. Monteggia Fractures - Trauma - Orthobullets 2018 Feb. 104 (1S):S113-S120. - 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). The Monteggia lesion. Data Trace is the publisher of The notoriously poor results of treatment of Monteggia fractures in adults improved dramatically after the development of modern techniques of plate-and-screw fixation, which facilitate early mobilization by ensuring anatomic reduction. The Orthobullets Podcast In this episode, we review the high-yield topic of Monteggia Fractures from the Trauma section. 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. (0/7), Level 3 The Monteggia lesion in children. A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. Tan SHS, Low JY, Chen H, Tan JYH, Lim AKS, Hui JH. Monteggia Fracture - Orthopedics - Medbullets Step 2/3 Please confirm that you would like to log out of Medscape. 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. Are you sure you want to trigger topic in your Anconeus AI algorithm? 2015 Nov. 31 (4):565-80. You are being redirected to Monteggia fractures in children and adults. - Post - Orthobullets More than 150 years later, in 1967, Bado coined the term Monteggia lesion and classified the injury into the following four types Children (Basel). anterior dislocation of radial head; Radial Head Fractures and Dislocations Questions & Answers - Medscape 2023 Lineage Medical, Inc. All rights reserved, PediatricsMonteggia Fracture - Pediatric. 2018 Oct. 102 (Suppl 1):93-102. Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. [QxMD MEDLINE Link]. Hume fracture - fracture of the olecranon accompanied by anterior dislocation of the radial head. Rang's children's fractures. 2015. Gemeinsam ist diesen 3 Formen die Kombination der Fraktur. A high index of suspicion, therefore, should be maintained with any ulna fracture. Datta T, Chatterjee N, Pal AK, Das SK. Introduction Giovanni Battista Monteggia, a surgical pathologist and public health official in Milan, first described the Monteggia fracture in 1814. Purpose: Monteggia variant defined as Monteggia fracture dislocation with radial head or neck fracture, coronoid fracture, ulnohumeral joint dislocation or combination of these injuries. [7] Interestingly, he described this injury pattern in the pre-Roentgen era solely on the basis of the history of injury and the physical examination findings. [Full Text]. Pronation injuries of the forearm, with special reference to theanterior Monteggia fracture. Xiao RC, Chan JJ, Cirino CM, Kim JM. In addition, there are substantial differences between Monteggia injuries in children and adults. The present multicenter retrospective study compared results for the Bouyala procedure with versus without plasty of the annular ligament of the radial head in evolved radial head lesion (Monteggia lesion), assessing the benefit of associating ligamentoplasty to ulnar osteotomy. Wheeless' Textbook of Orthopaedics. Radiographically, there were 15 good results, seven fair results, and zero poor results. [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%). (2/8), Level 5 (1/1), Level 4 PDF Case Report The MonteggiaFracture: literature review and report of a This article describes the diagnosis, treatment, and potential pitfalls encountered in the treatment of Monteggia fractures. - ref: Repair of Bado II Monteggia Fracture: Case Presentation and Surgical Technique. Advances in radiography and fracture research have helped define, classify, and guide operative management. Hand (N Y). [QxMD MEDLINE Link]. The aim of this study was to evaluate clinical outcomes of surgical treatment of Monteggia variant fracture dislocations with focus on the operative technique and management of associated radial head fractures. Acute pediatric Monteggia fractures: A. conservative approach to stabilization. - Giovanni Monteggia (1814) first described frx of proximal 1/3 of ulna in association w/ anterior dislocation of radial head; - hence dislocation of radial head w/ frx of proximal 1/3 of ulna is known as Monteggia's deformity. 8 (10):18197-202. Philadelphia: JB Lippincott; 1991. - immobilize forearm in neutral rotation w/ slight supination, w/ cast carefully molded over lateral side of ulna at level of fracture; Kathmandu Univ Med J (KUMJ). Must have high index of suspicion high incidence of missed injuries (Waters, 2010), Appropriate radiographic imaging is essential to making the correct diagnosis, Be aware of plastic deformation of the ulna. Monteggia Fracture - Pediatric - Pediatrics - Orthobullets 2020 Aug. 23 (4):233-237. - posterior interosseous nerve may be wrapped around neck of radius, preventing reduction; The Monteggia lesion. J Clin Diagn Res. Monteggia lesions in children and adults: an analysis of etiology and long-term results of treatment. A review of the complications. (0/1), Level 5 anteriorangulation (usually proximal third); There were twenty-five women and twenty-three men, and the average age was fifty-two years (range, eighteen to eighty-eight years). - anterior dislocation of the radial head; Stable anatomic reduction of the ulnar fracture results in anatomic reduction of the radial head. 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. Vol 1: Nakamura K, Hirachi K, Uchiyama S, Takahara M, Minami A, Imaeda T, et al. The anular (annular) and radial collateral ligaments stabilize the radial head. Leonidou A, Pagkalos J, Lepetsos P, Antonis K, Flieger I, Tsiridis E, et al. 2011 Feb. 77 (1):21-6. [QxMD MEDLINE Link]. [4] The radial head articulates with the humeral capitellum and the radial notch of the proximal ulna. 2015 Sep. 99 Suppl 1:S75-82.
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