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Monteggia fracture-dislocation
From WikEM
Contents
Background
- Common in kids (different treatment for kids)
- FOOSH
- Easy to overlook the radial head dislocation (will result in worse outcome)
Clinical Features
- Pain/swelling at elbow
- Radial head may be palpable in an anterolateral or posterolateral location
- Spontaneous relocation possible: must palpate directly over
- May be associated with radial nerve injury (wrist drop, inability to extend the fingers)
Complex Associated Injuries
- Terrible triad of elbow
- Coronoid fracture
- Radial head fracture
- Posterior elbow dislocation
- Open fracture
- Olecranon fracture-dislocation
- LCL injury
Differential Diagnosis
Forearm Fractures
- Distal radius fractures
- Radia ulna fracture
- Isolated radius fracture (proximal)
- Isolated ulna fracture (i.e. nightstick)
- Monteggia fracture-dislocation
- Galeazzi fracture-dislocation
- Forearm fracture (peds)
Evaluation
Adult Imaging
- Xray: AP, Lateral of elbow, forearm, wrist
- CT scan: Fractures involving coronoid, olecranon, and radial head
- Findings:
- proximal 1/3 Ulna fracture + radial head dislocation (due to ulna shortening)
- Radial head can dislocate anterior, posterior, or laterally
Pediatric Imaging
- Xray: AP, Lateral of elbow, forearm, wrist
- Assess radiocapitellar line on every lateral radiograph of the elbow: a line down the radial shaft should pass through the center of the capitellar ossification center[1]
- Findings: Radial head dislocation + proximal ulna fracture or plastic deformation of the ulna without obvious fracture
Management
- Consult ortho in the ED
- Long arm posterior splint with 90 degrees of elbow flexion and the hand in a neutral position
- Adults: likely requires ORIF
- Peds: possible long arm cast vs ORIF[2]
Disposition
Complications
- Consider open fracture (look for puncture wounds)
- Compartment syndrome
- Posterior Interosseous Neuropathy (PIN) - radial nerve branch; affects ~10% of Monteggia fractures
- Purely a motor syndrome resulting in finger drop, and radial wrist deviation on extension.
- Malunion with radial head dislocation
See Also
References
- ↑ de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.
- ↑ de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.
