Monteggia fracture dislocation
Patient with a history of fall on an outstretched hand (FOOSH), with subsequent intense pain and limited range of motion at the elbow joint. Obvious deformity on examination.
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There is a displaced fracture of the proximal third of the ulnar shaft, with resultant shortening also seen. An associated dislocation of the radial head is also noted, findings consistent with a Monteggia fracture dislocation. The apex of the ulnar fracture points in the same direction as the radial head dislocation.
Surrounding soft tissue swelling and a back slab in situ, are also seen.
This fracture is usually a result of a fall on an outstretched hand (FOOSH) and is more commonly seen in children. The eponymous term refers to a fracture of the ulnar shaft with associated anterior dislocation of the radial head. Further classification based on the direction of radial head displacement also exists, namely the Bado classification.
More attention should be paid towards looking for and assessing the radial head component of this fracture type, as this can be easily missed whereas the ulnar fracture is usually readily seen. Another potential feature that should be kept in mind when assessing a Monteggia fracture dislocation is a fracture of the distal radial shaft, which not uncommonly, may also be present.
- Monteggia Fracture Dislocations: A Historical Review. (2014) The Journal of Hand Surgery. 39 (7): 1384. doi:10.1016/j.jhsa.2014.02.024