What is a Monteggia variant fracture?
Introduction. Monteggia fracture is a combination of fracture of proximal ulnar shaft associated with radial head dislocation (proximal radio-ulnar joint subluxation or dislocation). Such an injury is not common among children but may be challenging and lead to serious complications if not treated in acute stage.
How does a Monteggia fracture occur?
Monteggia fractures are primarily associated with falls on an outstretched hand with forced pronation. If the elbow is flexed, the chance of a type II or III lesion is greater. In some cases, a direct blow to the forearm can produce similar injuries.
What are Monteggia variants?
The term “Monteggia variant” refers to additional traumatic pathologies around the elbow (e.g., additional fractures of the radial head or dislocation of the humeroulnar joint).
Why it is called Monteggia fracture?
The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius. It is named after Giovanni Battista Monteggia.
Which nerve is involved in Monteggia fracture?
Posterior interosseous nerve palsy is the most common nerve injury in Monteggia fracture-dislocations,. Most of these injuries are neuropraxia and recover slowly after the anatomical reduction of the radial head.
How do you treat a broken monteggia?
For Monteggia fracture-dislocations, best treatment includes ORIF of the ulna diaphyseal fracture. The ulna fracture is approached and reduced first. The radial head dislocation then usually reduces indirectly and is stable. (More than 90% of radial head dislocations are stable after fixation of the ulna.)
How do you prevent monteggia?
– posterior Monteggia frx is reduced by applying traction to forearm w/ the forearm in full extension; – immobilization is continued until there is union of the ulna; – this ordinarily requires 6-10 wks depending on the age of pt; – ref: Repair of Bado II Monteggia Fracture: Case Presentation and Surgical Technique.
What is the difference between Galeazzi and monteggia fracture?
Monteggia fractures and Monteggia variants are fractures of the proximal 1/3 ulna with concomitant proximal radioulnar joint (PRUJ) disruption (evident by radiocapitellar subluxation or dislocation). Galeazzi fractures are fractures of the radial shaft with concomitant dislocation of the distal radioulnar joint (DRUJ).
Why is it called a nightstick fracture?
The typical ulna fracture occurs as a result of an object impacting the forearm. The common term for an isolated ulna fracture is “nightstick” because it occurs as a result of a direct blow with a blunt object.
What kind of fracture is not a Monteggia fracture?
Such an isolated ulnar shaft fracture is not a Monteggia fracture. It is called a ‘nightstick fracture’. 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.
What to do with a displaced nightstick fracture?
Displaced nightstick fractures should be treated with open reduction and internal fixation using a 3.5mm dynamic compression plate. As opposed to Monteggia fractures in the pediatric population, which can be treated with closed reduction and casting, Monteggia fractures in adults require operative treatment.
What causes a nightstick fracture on the ulna shaft?
Ulna shaft fractures may occur from direct trauma along its subcutaneous border, classically described as a “nightstick fracture” as a victim attempts to protect the head from assault.
What are the complications of ORIF surgery for Monteggia fractures?
Complications of ORIF surgery for Monteggia fractures can include non-union, malunion, nerve palsy and damage, muscle damage, arthritis, tendonitis, infection, stiffness and loss of range of motion, compartment syndrome, audible popping or snapping, deformity, and chronic pain associated with surgical hardware such as pins, screws, and plates.