MONTEGGIA FRACTURE DISLOCATION
MONTEGGIA FRACTURE DISLOCATION
- This is a fracture of the upper-third of the ulna with dislocation of the head of the radius.
- It is caused by a fall on an out-stretched hand (hyperpronation injury).
- May also result from a direct blow on the back of the upper forearm.
- Fractures b/w the proximal third of the ulna and the base of olecranon combined with an anterior dislocation of the proximal radio ulnar joint.
Epidemiology:
- rare in adults
- more common in children with peak incidence between 4 and 10 years of age
TYPES
- 2 main categories depending upon the angulation of the ulna fracture – extension and flexion type.
- The extension type, is the commoner of the two, where the ulna fracture angulates anteriorly (extends) and the radial head dislocates anteriorly.
- The flexion type is where the ulna fracture angulates posteriorly (flexes) and the radial head dislocates posteriorly.
Bado’s classification of Monteggia Fracture
|
Type |
Direction of radial head dislocation |
Direction of apex of ulnar shaft fracture angulation |
| I (M/common) | Anterior | Anterior |
| II | Posterior | Posterior |
| Ill | Lateral | Lateral |
| IV | Anterior |
|
- Posterior interosseous nerve – most commonly injured nerve in forearm fractures, particularly in Monteggia fracture dislocation.
- Treatment: Rigid anatomical fixation by plating (DCP/LCDCP) is the method of choice.
Exam Important
- Monteggia fracture is fracture of the proximal third of the ulna with radial head dislocation.
- In Monteggia fracture Both ulnar fracture and head of radius is displaced anteriorly.
- Posterior interosseous nerve is injured in Monteggia fracture dislocation.
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