2008 Apr. - lateral or anterolateral dislocation of the radial head; 39 (4):451-5. Am J Orthop (Belle Mead NJ). PDF Monteggia Fractures in Adults* - upload.orthobullets.com The radius and ulna are closely invested by the interosseous membrane, which accounts for the increased risk of displacement or injury to the radius when the ulna fractures. J Hand Surg Am. - associated nerve injury: Bae, D. Successful strategies for managing Monteggia Injuries. PENROSE JH. (0/1), Level 2 Monteggia fracture-dislocation is rare in children 2,3,4. 2013 Jan;44(1):59-66. - radiohumeral ankylosis - Mechanism: - proposed mechanisms include direct blow & hyperpronation injuries as well- as the hyperextension theory; (0/7), Level 3 1998 Sep;27(9):606-9. Forearm fractures in children. What is the most likely finding? Radial Head Fractures and Dislocations Questions & Answers - Medscape (0/1), Level 3 [QxMD MEDLINE Link]. This fracture refers to an intraarticular fracture that separates the palmar ulnar aspect of the first metacarpal base from the remaining first metacarpal. [QxMD MEDLINE Link]. [10] studied the etiology of Monteggia fractures on cadavers by stabilizing the humerus in a vise and subjecting different forces to the forearm. 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. (6/78), Undecided A high index of suspicion, therefore, should be maintained with any ulna fracture. (1/7), Level 1 J Bone Joint Surg Br. - exam: - frx of proximal 1/3 of radius & frx of ulna at the same level; - Exam: Chronic Monteggia. (0/8). Fractures in children. Treatment can be isolated closed reduction in the pediatric population (if radiocapitellar joint remains stable). - medullary nail in this location may not fill the canal and may thus provide less than rigid fixation; Floriano Putigna, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic AssociationDisclosure: Nothing to disclose. The anular (annular) and radial collateral ligaments stabilize the radial head. 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. J Bone Joint Surg Br. 2020 Oct 1. (0/1), Level 1 2023 Lineage Medical, Inc. All rights reserved. Radiographically, there were 15 good results, seven fair results, and zero poor results. Findings associated with the concomitant radial head dislocation are often subtle and can be overlooked. - PIN or radial nerve palsy from anterior displacement of radial head; Monteggia fractures account for fewer than 5% of forearm fractures, with published literature supporting figures in the range of 1-2%. 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. Few contraindications for surgery exist. 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. J Am. Monteggia Fracture } Drake LeBrun MD Experts 3 Bullets 65 3.4 ( 5 ) 3 Images Snapshot A 35-year-old man presents to the emergency room for severe right elbow and forearm pain after sustaining a blunt injury to his right arm. 2016 Jun. Medscape Education. (20/80). "A Monteggia fracture with apex anterior ulnar shaft fracture is associated with an anterior radial head dislocation. A review of the complications. Philadelphia: Lippincott Williams & Wilkins; 2012: 351-65. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Children (Basel). Tan SHS, Low JY, Chen H, Tan JYH, Lim AKS, Hui JH. 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. 2021 Nov. 46 (11):1006-1015. 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, 2016 Current Solutions in Orthopaedic Trauma, Case Presentation: Chronic Monteggia Fx / Ulnar Nonunion. Monteggia fractures. - Post - Orthobullets Surgical management is indicated for radial heads that are not stable following closed reduction. The records concerning ten consecutive years of experience with Monteggia fractures in adult patients at a level-one trauma center were retrospectively reviewed. A Monteggia fracture involves a fracture of the ulna with disruption of the proximal radio-ulnar joint (PRUJ) and radiocapitellar dislocation (Bado, 1967). Since Monteggia first described the fracture bearing his name in 1814, the association of radial head dislocation with ipsilateral ulnar fracture has been well described. - this is esp true on the lateral projection; Monteggia Fracture - Orthopedics - Medbullets Step 2/3 The forearm structures are intricately related, and any disruption to one of the bones affects the other. We present an unreported configuration of a traumatic olecranon fracture with a concomitant medial radial head dislocation in a 3-year-old male.. The character of the ulnar fracture is useful in determining optimal treatment. 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. These injuries are relatively uncommon, accounting for fewer than 5% of all forearm fractures. ORTHOBULLETS; Events. Monteggia fractures in adults: long-term results and prognostic factors. Monteggia-type elbow fractures in childhood. - achieved w/ forarm in full supination, & longitudinal traction; 28 (19):e839-e848. Musculoskelet Surg. Pronation injuries of the forearm, with special reference to the anterior Monteggia fracture. (0/1), Level 5 In 1991, Anderson and Meyer used the following criteria to evaluate forearm fractures and their prognosis 2012 Jun. - in child, a dislocated radial head should never be resected, since it will cause cubitus valgus, prominence of distal end of ulna, [QxMD MEDLINE Link]. Instituzioni Chirrugiche. Are you sure you want to trigger topic in your Anconeus AI algorithm? (3/76), Level 1 (0/8), Level 2 (1/7), Level 5 The eponym Monteggia fracture is most precisely used to refer to a dislocation of the proximal radioulnar joint (PRUJ) in association with a forearm fracture, most commonly a fracture of the ulna. Monteggia Fracture: Practice Essentials, Anatomy, Pathophysiology Are you sure you want to trigger topic in your Anconeus AI algorithm? Adult Monteggia and Olecranon Fracture Dislocations of the Elbow. [QxMD MEDLINE Link]. Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. The relatively good results associated with nonoperative treatment of pediatric Monteggia injuries reflect the prevalence of stable (incomplete) fractures in children. The character of the ulnar fracture is useful in determining optimal treatment. Zivanovic D, Marjanovic Z, Bojovic N, Djordjevic I, Zecevic M, Budic I. Neglected Monteggia Fractures in Children-A Retrospective Study. (4/7). Forty-eight patients who had been followed for a minimum of two years (average, 6.5 years; range, two to fourteen years) were identified. [QxMD MEDLINE Link]. Watson-Jones R. Fracture and Joint injuries. If the elbow is flexed, the chance of a type II or III lesion is greater. - Type III - 20% 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, Undecided 2009 Jun. - realize that even w/ successful closed reduction of the ulna (and accompanying reduction of the radial head) that subsequently Monteggia Fractures in the pediatric population are defined as proximal ulna fractures or plastic deformation of the ulna with an associated radial head dislocation. Successful Strategies for Managing Monteggia Injuries. 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. [13] : Pain, nerve dysfunction, and cosmetic deformity are other factors to consider in evaluating the outcome of treatment in Monteggia fracture-dislocations. Treatment may be closed reduction and casting for length stable ulna fractures with a stable radiocapitellarjoint. for: Medscape. of flexion; Then divide the underlying padding with scissors (2) and remove the protective strip to expose the skin. In his classic 1943 text, Watson-Jones stated that "no fracture presents so many problems; no injury is beset with greater difficulty; no treatment is characterized by more general failure." (0/1), Level 5 2014 Jun. (26/80), Level 4 In a retrospective study on the functional and radiologic long-term outcome of ORIF in 11 skeletally mature patients with Bado type I Monteggia fractures, Guitton et al found that the mean arc of elbow flexion increased from 110 at early follow-up to 120 at late follow-up. Diagnosis can be made with plain radiographs of the elbow. The result was excellent for eighteen patients, good for twenty-two, fair for two, and poor for six. : A retrospective study. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Monteggia GB. - Discussion: [15] The average follow-up period was 5.5 years. 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). (0/1). After undergoing closed reduction, the radiocapitellar joint is noted to remain non-concentric.
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