Monteggia fracture

Classification according to ICD-10
S52.21	Fracture of the proximal ulnar shaft with dislocation of the radial head Monteggia fracture
ICD-10 online (WHO version 2019)

The Monteggia fracture is a 1813 first by Giovanni Battista Monteggia described combination fracture of the forearm. The proximal part of the ulna is broken . At the same time, the head of the spoke is dislocated, mostly forwards and away from the body - that is, anteriorly and laterally , and rarely luxated backwards .

X-ray of a Monteggia fracture in a child. In addition to the easily recognizable rupture of the ulna, there is a dislocation of the spoke. The not yet ossified spoke head (blue arrow) should be exactly opposite the bone core of the humerus head (red arrow).

causes

The Monteggia fracture is mostly the result of an accident involving high energies. Most of these injuries result from traffic accidents. In addition, if you fall on the forearm while bending the elbow or parrying blows with the forearm , the fracture can occur.

In children, the mechanism of injury is the fall on the arm pronated at the elbow .

diagnosis

The diagnosis of a Monteggia fracture is made using a conventional X-ray . The forearm with the elbow is X-rayed from the front and the side. Looking at it from the side, in particular, you can judge to what extent the head of the spoke is dislocated. The radial head must center on the humeral capitulum in both planes (!).

A frequent cause of failure to recognize is that the elbow is not shown or cannot be assessed.

If the radius head is not yet bony in small children, correct centering can be demonstrated by ultrasound .

Classification

The Monteggia fracture is classified according to the AO classification or Bado. Bado distinguishes between four types:

Type	Fracture site	Kink of the fracture	dislocation
I.	proximal third of the ulna	ventrally	ventral
II	proximal third of the ulna	dorsally	dorsal
III	Metaphysis of the ulna		lateral or anterolateral
IV	proximal third of the radius and ulna		ventral dislocation of the radius fragment

The type I fracture accounts for about 60–80% of all Monteggia fractures.

Complications

With a Monteggia fracture, the radial nerve (→ radial paralysis ) and the vessels of the elbow can be damaged. This can lead to the compartment syndrome . Furthermore, the head of the spoke can be broken and the ligaments of the elbow joint torn.

therapy

As a rule, after exact repositioning, the fracture of the ulna is surgically stabilized with metal plates , in children with intramedullary splinting. The ribbons of the spoke may need to be sewn. Surgical therapy is followed by immobilization in a cast for three to four weeks.

Missed radial head dislocation

If the malalignment of the radial head is not discovered, it will heal in the malalignment with restricted mobility. Therapy is then much more complex, the prognosis depends, among other things, on the age of the child and the duration of the dislocation.

See also

• Galeazzi fracture

literature

• Gustav H. Engelhardt, Heinz G. Engelhardt: Accident medicine: A guide for clinic and practice . Walter de Gruyter, 1998, ISBN 3-11-015096-4 .
• Jacques Duparc, Norbert Gschwend, Roger Lemaire: Surgical Techniques in Orthopedics and Traumatology . Urban & Fischer, 2005, ISBN 3-437-22536-7 .
• S1 guideline for forearm shaft fractures in childhood of the German Society for Pediatric Surgery (DGKCH). In: AWMF online (as of 2013)

Web links

Commons : Monteggia Fractures  - Collection of Images, Videos, and Audio Files

Individual evidence

1. ^ JL Bado: The Monteggia lesion. In: Clin Orthop. 1962, 50, pp. 71-86.
2. ^ T. Slongo, FF Fernandez: The Mishealed Monteggia Injury in Childhood and Adolescence. In: The trauma surgeon. 2011. doi: 10.1007 / s00113-011-1961-6

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !