Monteggia Fracture Workup

  • Author: Floriano Putigna, DO, FAAEM; Chief Editor: Harris Gellman, MD   more...
 
Updated: Jan 26, 2010
 

Laboratory Studies

  • Laboratory studies may be obtained as indicated by the patient's medical history, to assist with anesthesia and perioperative management.
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Imaging Studies

  • Plain radiography
    • Technique - Views of the forearm in orthogonal planes (planes at 90° to each other) are needed with the wrist and elbow joints included. The evaluating physician should also obtain separate radiographs of the elbow to assess the proximal radioulnar joint, ulnohumeral articulation, and the radiocapitellar joint.
    • Findings - The ulna fracture is usually obvious, but the findings associated with the radial head dislocation may be subtle and overlooked. In order to assess the radiocapitellar joint, a line should be drawn parallel to the long axis of the radius. This line should point directly at the capitellum on any projection of the elbow. The radial head dislocation almost always points in the same direction as the apex of the ulna fracture. In children, recognizing a plastic deformation of the ulna, which may also lead to radial head dislocation, is important.
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Staging

See Bado classification of Monteggia fracture-dislocations.

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Contributor Information and Disclosures
Author

Floriano Putigna, DO, FAAEM  Staff Physician, Florida Emergency Physicians, Inc., Maitland; Florida Hospital

Floriano Putigna, DO, FAAEM, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Coauthor(s)

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

Disclosure: Nothing to disclose.

Richard L Ursone, MD  Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, Brooke Army Medical Center

Richard L Ursone, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and Society of Military Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven I Rabin, MD  Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic

Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Fracture Association, AO Foundation, and Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Robert J Nowinski, DO  Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio

Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Osteopathic Surgeons, American Medical Association, American Osteopathic Association, Ohio Osteopathic Association, and Ohio State Medical Association

Disclosure: Tornier Grant/research funds Other; Tornier Honoraria Speaking and teaching

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

  1. Monteggia GB. Instituzioni Chirrugiche. vol 5. Milan: Maspero; 1814.

  2. Bado JL. The Monteggia lesion. Clin Orthop Relat Res. Jan-Feb 1967;50:71-86. [Medline].

  3. Guitton TG, Ring D, Kloen P. Long-term evaluation of surgically treated anterior monteggia fractures in skeletally mature patients. J Hand Surg Am. Nov 2009;34(9):1618-24. [Medline].

  4. Nakamura K, Hirachi K, Uchiyama S, Takahara M, Minami A, Imaeda T, et al. Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children. J Bone Joint Surg Am. Jun 2009;91(6):1394-404. [Medline].

  5. Watson-Jones R. Fracture and Joint injuries. Vol. 2. 3rd edition. Baltimore: Williams and Wilkins; 1943:P. 520.

  6. Bruce H.E., Harvey J.P., Wilson J.C. Monteggia Fractures. J Bone Joint Surg Am. 1974;56:1563.

  7. Reckling F.W. Unstable fracture-dislocation of the forearm (Monteggia and Galeazzi lesions). J Bone Joint Surg Am. 1982;64:857.

  8. Evans EM. Pronation injuries of the forearm with special reference to anterior Monteggia fractures. J Bone Joint Surg. 1949;31B:578-588.

  9. Penrose JH. The Monteggia fracture with posterior dislocation of the radial head. J Bone Joint Surg. 1951;33B:65-73.

  10. Ruchelsman DE, Pasqualetto M, Price AE, Grossman JA. Persistent posterior interosseous nerve palsy associated with a chronic type I monteggia fracture-dislocation in a child: a case report and review of the literature. Hand (N Y). Jun 2009;4(2):167-72. [Medline].

  11. Tan JW, Mu MZ, Liao GJ, Li JM. Pathology of the annular ligament in paediatric Monteggia fractures. Injury. Apr 2008;39(4):451-5. [Medline].

  12. Anderson LE, Meyer FN. Fractures of the shafts of the radius and ulna. In: Rockwood CA, Green DP, and Bucholz R, eds. Fractures in Adults. vol 1. 3rd ed. Philadelphia, Pa: JB Lippincott; 1991.

  13. Anderson LD, Sisk D, Tooms RE, et al. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am. Apr 1975;57(3):287. [Medline].

  14. Boyd HB, Boals JC. The Monteggia lesion. A review of 159 cases. Clin Orthop Relat Res. Sep-Oct 1969;66:94-100. [Medline].

  15. Huang E, Grimes P. Fractures, forearm. eMedicine [serial online]. Available at http://emedicine.medscape.com/article/824949-overview.

  16. Jessing P. Monteggia lesions and their complicating nerve damage. Acta Orthop Scand. Sep 1975;46(4):601-9. [Medline].

  17. Jupiter JB, Leibovic SJ, Ribbans W, et al. The posterior Monteggia lesion. J Orthop Trauma. 1991;5(4):395-402. [Medline].

  18. LD Anderson, D Sisk, RE Tooms and WI Park. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J of Bone Joint Surgery. 1975;57:292. [Full Text].

  19. McLaughlin HL. Trauma. Philadelphia, Pa: WB Saunders; 1959.

  20. Mullick S. The lateral Monteggia fracture. J Bone Joint Surg Am. Jun 1977;59(4):543-5. [Medline].

  21. Overly F, Steele D. Common pediatric fractures and dislocations. Clinical Pediatric Emergency Medicine. 2002;3(2):106-117.

  22. Perron AD, Hersh RE, Brady WJ, et al. Orthopedic pitfalls in the ED: Galeazzi and Monteggia fracture-dislocation. Am J Emerg Med. May 2001;19(3):225-8. [Medline].

  23. Ring D, Jupiter JB, Simpson NS. Monteggia fractures in adults. J Bone Joint Surg Am. Dec 1998;80(12):1733-44. [Medline].

  24. Ring D, Jupiter JB, Waters PM. Monteggia fractures in children and adults. J Am Acad Orthop Surg. Jul-Aug 1998;6(4):215-24. [Medline].

  25. Speed JS, Boyd HB. Treatment of fractures of the ulna with dislocation of the head of the radius. JAMA. 1940;115:1699-1704.

  26. Strauss EJ, Tejwani NC, Preston CF, et al. The posterior Monteggia lesion with associated ulnohumeral instability. J Bone Joint Surg Br. Jan 2006;88(1):84-9. [Medline].

 
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Bado type I lesion. This is the most common type of Monteggia fracture.
Bado type I lesion.
Bado type II lesion.
Bado type II lesion after open reduction and internal fixation.
Bado type III lesion with lateral displacement of the radial head.
Bado type III lesion with lateral displacement of the radial head.
Bado type IV lesion.
 
 
 
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