Monteggia fracture-dislocation

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

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

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

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Article Information

rID: 1690
Synonyms or Alternate Spellings:
  • Monteggia fracture dislocation
  • Monteggia fracture

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Cases and Figures

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    Case 1
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    Monteggia fracture
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    Case 3
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    Case 5: combined Monteggia and Galeazzi fractures
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