![]() ![]() ![]() Clinical diagnosis can be missed in the subtle ulna plastic deformation fracture and significantly displaced radius and ulna shaft fractures (Bae, 2016). Proximal radius dislocations can also occur with mid-shaft forearm fractures. Dynamic imaging with fluoroscopy may be helpful as well. When unclear, obtaining an AP and lateral x-ray of the contralateral elbow can be helpful. Beware of plastic deformation of the ulna, which can be easily missed but still associated with radiocapitellar dislocation. Radiocapitellar alignment should be checked on all views and the radial shaft should point to the center of the capitellum in all positions on any radiographic view. AP and lateral films of the forearm as well as the elbow and wrist should be obtained. This includes posterior interosseous nerve (PIN) and ulnar nerve neuropraxia, typically seen with Bado III and II, respectively (Waters, 2012).Īppropriate imaging is essential to avoid missing this injury. Neurologic deficit is present at presentation in 10-20% of the cases. Forearm deformity may or may not be present and limitations in range of motion are not always obvious. Patients usually present with a history of a fall onto an outstretched hand and pain in the forearm and elbow. The type of fracture depends largely on the mechanism of injury (Evans, 1949). They typically occur in children between 4 and 10 years of age after a fall onto an outstretched hand. This fracture pattern was first described in 1814 by Giovanni Monteggia. Monteggia fractures account for 0.4% of all forearm fractures in children. Proximal radius dislocations in skeletally immature teenagers and children occur in the setting of a spectrum of ulnar injuries that often do not follow classic adult patterns. Be aware of plastic deformation of the ulnaĪ Monteggia fracture involves a fracture of the ulna with disruption of the proximal radio-ulnar joint (PRUJ) and radiocapitellar dislocation (Bado, 1967).Appropriate radiographic imaging is essential to making the correct diagnosis.Must have high index of suspicion – high incidence of missed injuries (Waters, 2010).Study Guide Monteggia Fracture Key Points: ![]()
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