All Monteggia fracture-dislocations require an urgent orthopedic assessment. Reduction is always required. Delayed or missed diagnosis is the most frequent. Monteggia fractures account for approximately 1% to 2% of all forearm fractures. Distal forearm fractures are far more frequent than midshaft. Monteggia fracture-dislocations consist of a fracture of the ulnar shaft with concomitant dislocation of the radial head. The ulnar fracture is usually obvious.
|Published (Last):||12 February 2015|
|PDF File Size:||17.91 Mb|
|ePub File Size:||18.65 Mb|
|Price:||Free* [*Free Regsitration Required]|
To better recognize subtle dislocations, a line can be drawn through the radial shaft and head.
Monteggia Fracture – Pediatric
Additional radiographs of the distal wrist and proximal elbow should be obtained with any suspicion of coexistent injury. Fractire video describe the clinical presentation and XR findings in Monteggia fract Maisonneuve fracture Le Fort fracture of ankle Bosworth fracture. J Hand Surg Am. An anteroposterior and lateral view will usually identify the injury. History and physical exam begins any assessment. The Royal Children’s Hospital Melbourne. Operative fixation must address ulnar length, alignment and rotation and provide adequate stability for early range of motion.
Monteggia Fractures – Trauma – Orthobullets
Most of these fractures will be treatable non-operatively. A line drawn down the shaft of the radius should point to the center of the capitellum radiocapitellar line in both AP and lateral x-ray views to exclude joint dislocation. Missing the pediatric Monteggia leads to poor results. Chronic Mknteggia fracture malunion in a 12yo boy C Pediatrics – Monteggia Fracture – Pediatric HPI – 12 yo boy presents with Left elbow pain and a history of an ulna shaft fracture 3 years ago.
In adults, the most common presentation involves an axial force resulting in apex posterior deformity of the ulna and a posterior dislocation of the radial head.
The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius. In the pediatric population, operative motneggia include an inability to obtain and maintain reduction of the radial head through the healing process. Thank you for rating!
Monteggia fracture-dislocations – Emergency Department
If it is not straight, it indicates a plastic deformation injury. The most significant risk factors for midshaft forearm fractures include sports football and wrestlingosteoporosis, and post-menopausal phase.
Affilations 1 Univeristy of Tennessee Nashville. Adults Operative management is crucial for the majority of adult Monteggia fractures. In most cases, a single compression plate is placed with approximately six cortical screws anchored proximally and distally. Since the radial head provides a degree of stability to the elbow, only very fractuge and undisplaced fractures may be treated closed. Because Monteggia fractures monteggiz involve disruption of the radiocapitellar joint, these injuries all require some form of intervention.
A thorough inventory of all injured structures will be critical in formulating an appropriate treatment plan. Lisfranc Monteggka March Calcaneal. Residual radiocapitellar instability is almost always a result of residual ulnar deformity.
There must also be a true AP and lateral view of the elbow not just a forearm view to assess the radiocapitellar joint. The arc of the radial head articular surface will be well visualized and should be concentric with the capitellum. Examination of the proximal and distal joint should be performed to identify concomitant fractire. What is the most appropriate treatment?
What is the usual ED management for this fracture? Avoid probing open wounds.
The osseous forearm is composed of the radius and ulna bones. Summary Monteggia fracture-dislocations can be easily missed on x-ray.