The result was excellent for eighteen patients, good for twenty-two, fair for two, and poor for six. Monteggia Fractures - Trauma - Orthobullets orthoBULLETS MBBULLETSStep 1For 1st and 2nd Year Med Students MBBULLETSStep 2 & 3For 3rd and 4th Year Med Students ORTHOBULLETSOrthopaedic Surgeons & Providers JOIN NOWLOGIN Home Topics Techniques Cards QBank Evidence Cases Videos Podcasts Groups Products Trauma Spine Shoulder & Elbow Knee & Sports [QxMD MEDLINE Link]. In 1991, Anderson and Meyer used the following criteria to evaluate forearm fractures and their prognosis (0/1). Monteggia GB. Orthop Traumatol Surg Res. (0/7), Level 2 A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. J Pediatr Orthop 2015; 35 (2) 115-120. [7] Cao YQ, Deng JZ, Zhang Y, Yuan XW, Liu T, Li J, et al. J Pediatr Orthop 2017: 37(6): e335-e341.Penrose JH. Most nerve injuries are neurapraxias and typically resolve over a period of 4-6 months. (1/1), Level 4 Monteggia fractures in children and adults. Rang, M., Pring, M. E., & Wenger, D. R. (2005). [Full Text]. 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 Monteggia fracture with apex anterior ulnar shaft fracture is associated with an anterior radial head dislocation. Orthobullets - "A Monteggia fracture with apex anterior | Facebook Monteggia fracture-dislocations remain a relatively uncommon injury. (0/7), Level 3 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. This article describes the diagnosis, treatment, and potential pitfalls encountered in the treatment of Monteggia fractures. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTIzMTQzOC1vdmVydmlldw==, Type I - Fracture of the proximal or middle third of the ulna with anterior dislocation of the radial head (see the first and second images below), Type II - Fracture of the proximal or middle third of the ulna with posterior dislocation of the radial head (see the third and fourth images below), Type III - Fracture of the ulnar metaphysis with lateral dislocation of the radial head (see the fifth and sixth images below), Type IV - Fracture of the proximal or middle third of the ulna and radius with anterior dislocation of the radial head (see the seventh image below), Excellent - Union with less than 10 loss of elbow and wrist flexion/extension and less than 25% loss of forearm rotation, Satisfactory - Union with less than 20 loss of elbow and wrist flexion/extension and less than 50% loss of forearm rotation, Unsatisfactory - Union with greater than 30 loss of elbow and wrist flexion/extension and greater than 50% loss of forearm rotation, Failure - Malunion, nonunion, or chronic osteomyelitis. head is not promptly reduced; - following reduction, radial head will be stable if left in flexion; The median and ulnar nerves enter the antecubital fossa just distal to the elbow. An Alternative to the Traditional Radiocapitellar Line for Pediatric Forearm Radiograph Assessment in Monteggia Fracture. Ulna - Physiopedia Stitgen A, McCarthy JJ, Nemeth BA, Garrels K, Noonan KJ. : A retrospective study, Mortons Neuroma: Interdigital Perineural Fibrosis, Orthopaedic Specialists of North Carolina. A review of the complications. 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. Monteggia fractures account for fewer than 5% of forearm fractures, with published literature supporting figures in the range of 1-2%. Share cases and questions with Physicians on Medscape consult. The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius. Chin J Traumatol. Tan SHS, Low JY, Chen H, Tan JYH, Lim AKS, Hui JH. Bennett fracture is the most common fracture involving the base of the thumb. [1], The first challenge is correctly assessing the extent and nature of the injury. 2023 Lineage Medical, Inc. All rights reserved. Pathology of the annular ligament in paediatric Monteggia fractures. It is the character of the ulnar fracture, rather than the direction of radial head dislocation, that is useful in determining the optimal treatment of Monteggia fractures in both children and adults. (2/7), Level 4 The other two unsatisfactory results were in a patient who had had a Bado type-I fracture and in one who had had a Bado type-IV fracture. - recurrent radial head dislocation Monteggia fractures in adults. - Post - Orthobullets J Pediatr Orthop. - anterior dislocation of radial head (or frx) and fracture of ulnar diaphysis at any level w/ Are you sure you want to trigger topic in your Anconeus AI algorithm? Monteggia fractures are one third as common as the more . Dhoju D, Parajuli B. Functional Outcome of Pediatric Monteggia Fracture Dislocation Treated Surgically in a Tertiary Care Centre of Nepal. 36 (2):65-73. (0/1), Level 5 According to the classification of Bado, there were seven type-I, thirty-eight type-II, one type-III, and two type-IV injuries. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. The posterior (Bado type-II) fracture is the most common type of Monteggia fracture in adults. The Monteggia fracture with posterior dislocation of the radial head. [2 . Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. PDF Monteggia fracture dislocation equivalents analysis of eighteen cases (OBQ10.240) (20/80). Ramski, D., Hennrikus, W., Bae, D., et. 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. - reduction: 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. A 45-year-old male falls off his motorcycle and injures his arm. Philadelphia: Lippincott Williams & Wilkins; 2012: 351-65. Xiao RC, Chan JJ, Cirino CM, Kim JM. Bado believed that the type III lesion, the result of a direct lateral force on the elbow, was primarily observed in children. A 12-year-old male sustains an ulnar fracture with an associated posterior-lateral radial head dislocation. The first case is a combined type III Monteggia injury with ipsilateral Type II Salter-Harris injury of the distal end radius fracture with metaphyseal fracture of the Soni JF, Valenza WR, Pavelec AC. - see: nerve injuries Clin Orthop Relat Res. [QxMD MEDLINE Link]. - 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). - in child, a dislocated radial head should never be resected, since it will cause cubitus valgus, prominence of distal end of ulna, - Mechanism: 91 (6):1394-404. This eponym is among the most widely recog nized by orthopaedic surgeons, largely because of the notoriously poor results associated with the treatment of these injuries, particularly in adults83948. Monteggia fractures are one third as common as the more familiar Galeazzi fractures. Adults and unstable injuries generally require ORIF of the ulna. Am J Orthop (Belle Mead NJ). [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. Fractures of the shafts of the radius and ulna. - posterior interosseous nerve may be wrapped around neck of radius, preventing reduction; 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. Wheeless' Textbook of Orthopaedics. Other important complications included proximal radioulnar synostosis in three patients, ulnar malunion in three, posterolateral rotatory instability of the ulnohumeral joint in one, and instability of the distal radioulnar joint in one. Philadelphia: Lippincott Williams &Wilkins; 2010: 446-74. J Orthop Trauma. [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%). 36 Suppl 1:S67-70. Monteggia's Fracture : Wheeless' Textbook of Orthopaedics [6] Injuries to the anterior interosseous branch of the median nerve and the ulnar nerve also have been reported. Bado [1] classification in Monteggia fracture-dislocations and 35 (3):e434-7. Ulnar fracture with late radial head dislocation: delayed Monteggia fracture. [QxMD MEDLINE Link]. Di Gennaro GL, Martinelli A, Bettuzzi C, Antonioli D, Rotini R. Outcomes after surgical treatment of missed Monteggia fractures in children. Curr Opin Pediatr. The posterior interosseous nerve travels around the neck of the radius and dives under the supinator as it courses into the forearm. The Galeazzi fracture is a fracture of the middle to distal one-third of the radius associated with dislocation or subluxation of the distal radioulnar joint (DRUJ). What are floating elbow injuries and how are they treated? : A retrospective study. TraumaMonteggia Fractures - The Orthobullets Podcast - Podcast 2012 Feb. 35 (2):138-44. [13] : Pain, nerve dysfunction, and cosmetic deformity are other factors to consider in evaluating the outcome of treatment in Monteggia fracture-dislocations. Monteggia fracture - fracture of the proximal 1/3 of the ulnar shaft accompanied by the dislocation of the radial head. Steven I Rabin, MD, FAAOS Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Musculoskeletal Services, Dreyer Medical Clinic Is Bone Mineral Density Testing Underused in Prostate Cancer Care? 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. (1/1), Level 4 Pathology of the annular ligament in paediatric Monteggia fractures Bennett Fracture - StatPearls - NCBI Bookshelf - fracture of ulnar metaphysis; Towson, MD 21204 Medscape Education. - realize that even w/ successful closed reduction of the ulna (and accompanying reduction of the radial head) that subsequently Neural injuries are generally traction injuries and result from stretching around the displaced bone or from energy dispersed during the initial injury. Findings associated with the concomitant radial head dislocation are often subtle and can be overlooked. constantpressure exerted by the dislocated radial head; (1/7), Level 5 Forty-eight patients who had been followed for a minimum of two years (average, 6.5 years; range, two to fourteen years) were identified. HTML view of the file Chapter 10.html Successful Strategies for Managing Monteggia Injuries. Monteggia Fractures - Trauma - Orthobullets Reckling FW. The investigators evaluated outcomes on the basis of the 100-point MEPI, radiology, and questionnaire. Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. Bado type II lesion after open reduction and internal fixation. [Full Text]. - hence dislocation of radial head w/ frx of proximal 1/3 of ulna is known as Monteggia's deformity. Closed reduction; cast immobilization for Monteggia lesion - AO Foundation Transolecranon fracture-dislocation of the elbow - PubMed [QxMD MEDLINE Link]. 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. Surgical treatment of Monteggia variant fracture dislocations of the More than 150 years later, in 1967, Bado coined the term Monteggia lesion and classified the injury into the following four types [14]. Proximal radius dislocations in skeletally immature teenagers and children occur in the setting of a spectrum of ulnar injuries that often do not follow classic adult patterns. (0/1), Level 2 J Bone Joint Surg Br.
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