Monteggia fracture-dislocations comprise of a fracture of the ulna shaft and dislocation of the radial head. The ulna fracture is usually very obvious whereas the radial head dislocation can be overlooked, with potentially serious functional and medico-legal ramifications.
Typically Monteggia fracture-dislocations occur as the result of a fall on an outstretched arm 4.
The Bado classification is used to subdivide the fracture-dislocation into four types which all have different treatment options and prognoses, and is based on the principle that the direction in which the apex of the ulnar fracture points is the same direction as the radial head dislocation 3. As is usually the case, in everyday practice describing the fracture / dislocation is far more important than remembering the grade.
When a forearm fracture is identified, it is important to image both the elbow and the wrist, and good quality AP and lateral views are required. The fracture is usually obvious, although in children Monteggia equivalent injuries can be present where the ulnar merely flexed or developed a subtle greenstick fracture.
The radial head dislocation, provided adequate films are obtained, should be readily identifiable, although in the paediatric elbow, care should be taken to take into account the age-dependent appearance of the elbow centers of ossification.
Treatment and prognosis
All four types of Monteggia fracture-dislocations (see Bado classification) are treated with open reduction and internal fixation. Types I, III, IV are cast to 110 degrees, whereas type II is cast to 70 degrees of flexion 4,6.
History and etymology
It is named after Giovanni Battista Monteggia, Italian surgeon (1762-1815), who first described the Bado type I fracture in 1814, a year before his death 5-6.
- 1. Konrad GG, Kundel K, Kreuz PC et-al. Monteggia fractures in adults: long-term results and prognostic factors. J Bone Joint Surg Br. 2007;89 (3): 354-60. doi:10.1302/0301-620X.89B3.18199 - Pubmed citation
- 2. Wiley JJ, Galey JP. Monteggia injuries in children. J Bone Joint Surg Br. 1985;67 (5): 728-31. J Bone Joint Surg Br (link) - Pubmed citation
- 3. Iyer RS, Thapa MM, Khanna PC et-al. Pediatric bone imaging: imaging elbow trauma in children--a review of acute and chronic injuries. AJR Am J Roentgenol. 2012;198 (5): 1053-68. doi:10.2214/AJR.10.7314 - Pubmed citation
- 4. Cooper G. Blueprints Orthopedics. Blackwell Publishers. (2005) ISBN:1405104015. Read it at Google Books - Find it at Amazon
- 5. Bado JL. The Monteggia lesion. Clin. Orthop. Relat. Res. 50 : 71-86. - Pubmed citation
- 6. Williams GR, Ramsey ML, Wiesel SW. Operative Techniques in Shoulder and Elbow Surgery. Lippincott Williams & Wilkins. (2010) ISBN:145110264X. Read it at Google Books - Find it at Amazon
Wrist and hand fractures
- wrist and hand fractures (Amsterdam wrist rules)
- distal radial fracture (Frykman classification)
- distal ulna fractures
- fracture dislocations of the radius and ulna
- carpal fractures
- metacarpal fractures
- phalanx fractures