Monteggia Fracture Clinical Presentation

Updated: Nov 13, 2018
  • Author: Floriano Putigna, DO, FAAEM; Chief Editor: Murali Poduval, MBBS, MS, DNB  more...
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Presentation

History

Following the mechanism previously described (see Pathophysiology), patients present with elbow pain. Depending on the type of fracture and severity, they may experience elbow swelling, deformity, crepitus, and paresthesia or numbness. Some patients may not have severe pain at rest, but elbow flexion and forearm rotation are limited and painful.

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Physical Examination

The dislocated radial head may be palpable in the anterior, posterior, or anterolateral position. In Bado type I and IV lesions, the radial head can be palpated in the antecubital fossa. The radial head can be palpated posteriorly in type II lesions and laterally in type III lesions.

The skin should be closely inspected to ensure that an open fracture is not present. Pulses and capillary refill should be documented. A negligible hematoma may be present at the site if no direct trauma is associated.

Motor function must be thoroughly tested because the branches of the radial nerve can become entrapped, causing weakness or paralysis of finger or thumb extension. The sensory branch is not usually involved but also should be checked. Bado indicated that spontaneous recovery is the usual course, and exploration is appropriate if function does not begin to return within 2-3 months.

Monteggia fractures in the pediatric population typically manifest with unique features that have led to a decreased emphasis on the direction of the radial head dislocation and an increased focus on the character of the fracture of the ulna. When the various fracture types occur in the immature bone of children, distinct patterns result and influence treatment considerations.

Monteggia fractures in children may be categorized according to the type of ulnar injury, as follows:

  • Plastic deformation
  • Incomplete (greenstick or buckle) fracture
  • Complete transverse or short oblique fracture
  • Comminuted or long oblique fracture

Plastic deformation of the ulna in association with anterior radial head dislocation represents up to 31% of anterior Monteggia lesions. Poor recognition of this injury pattern can lead to recurrent or persistent dislocation because the radial head reduction remains unstable until the plastic deformity is corrected. Incomplete fractures of the ulna and greenstick fractures represent other variants that must be corrected along with the radial head dislocation.

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