The Monteggia fracture
is a fracture of the ulna
The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form and runs parallel to the radius, which is shorter and smaller. In anatomical position The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form...
that affects the joint with the radius
The radius is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna, which exceeds it in length and size. It is a long bone, prism-shaped and slightly curved longitudinally...
. More precisely, it is a fracture of the proximal third of the ulna with dislocation of the head of the radius
The head of the radius has a cylindrical form, and on its upper surface is a shallow cup or fovea for articulation with the capitulum of the humerus....
. It is named after Giovanni Battista Monteggia
Giovanni Battista Monteggia was an Italian surgeon. Monteggia fracture is named for him.-Biography:He began training as a surgeon at age seventeen in Milan. He got his doctorate of medicine in 1789 at University of Pavia. In the same year, his first book, Fasciculi Pathologici, was published...
- Fall on an outstretched hand with the forearm in excessive pronation
In anatomy, pronation is a rotational movement of the forearm at the radioulnar joint, or of the foot at the subtalar and talocalcaneonavicular joints. For the forearm, when standing in the anatomical position, pronation will move the palm of the hand from an anterior-facing position to a...
- Direct blow on back of upper forearm. In this context, Monteggia fractures are most commonly seen in defense against blunt trauma (e.g. nightstick injury).
Classification (Bado type)
There are four types (depending upon displacement of the radial head):
- I - Extension type (60%) - ulna shaft angulates anteriorly (extends) and radial head dislocates anteriorly.
- II - Flexion type (15%) - ulna shaft angulates posteriorly (flexes) and radial head dislocates posteriorly.
- III - Lateral type (20%) - ulna shaft angulates laterally (bent to outside) and radial head dislocates to the side.
- IV - Combined type (5%) - ulna shaft and radial shaft are both fractured and radial head is dislocated, typically anteriorly.
Monteggia fractures may be managed conservatively in children with closed reduction (resetting and casting
An orthopedic cast, body cast or surgical cast, is a shell, frequently made from plaster, encasing a limb to hold a broken bone in place until healing is confirmed...
), but due to high risk of displacement causing malunion, open reduction internal fixation is typically performed.
In children, the results of early treatment are quite good, typically normal or nearly so. If diagnosis is delayed, reconstructive type surgery is needed and complications are much more common and results poorer. In adults, the healing is slower and results usually not as good.
Complications of ORIF surgery
Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone, a concept that dates to the mid-19th century...
for Monteggia fractures can include non-union, malunion, nerve palsy and damage, muscle damage, arthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....
Tendinitis , meaning inflammation of a tendon , is a type of tendinopathy often confused with the more common tendinosis, which has similar symptoms but requires different treatment...
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
, stiffness and loss of range of motion
Joint stiffness may be either the symptom of pain on moving a joint, the symptom of loss of range of motion or the physical sign of reduced range of motion. Doctors prefer the latter two uses but patients often use the first meaning....
, compartment syndrome
Compartment syndrome is a limb threatening and life threatening condition, defined as the compression of nerves, blood vessels, and muscle inside a closed space within the body . This leads to tissue death from lack of oxygenation due to the blood vessels being compressed by the raised pressure...
, audible popping or snapping, deformity, and chronic pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
associated with surgical hardware such as pins, screws, and plates. Several surgeries may be needed to correct this type of fracture as it is almost always a very complex fracture that requires a skilled orthopedic surgeon, usually a 'specialist', familiar with this type of injury.