Monteggia fracture

The Monteggia fracture (1813 first described by Giovanni Battista Monteggia ) is a combination fracture of the forearm. It breaks the proximal ( proximal ) portion of the ulna. At the same time the spoke head is dislocated towards the body - that is dislocated anteriorly and laterally.

Causes

The Monteggia fracture is usually caused by an accident, in which acting high energies. Most of these injuries occur in traffic accidents. In addition, the fracture in a fall on the forearm during flexion of the elbow or on parrying of blows may arise with the forearm. In children, the injury mechanism of the fall is stretched to the elbow, pronated arm.

Diagnosis

The diagnosis of a Monteggia fracture is found in the conventional radiograph. Here, the forearm is x-rayed with the elbow from the front and from the side. In particular, in the lateral view you can assess the extent to which the spoke head is dislocated. The radial head must be centered on the capitulum humeri in both planes ( ).

A frequent cause of non- recognition is that the elbow is not or can not be assessed with imaged.

Is the head of the radius in young children not yet created bony, correct centering can be detected on ultrasound.

Classification

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

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

Complications

In a Monteggia fracture of the radial nerve (→ radial nerve ), and the vessels of the elbow may be damaged. As a result, it may come to compartment syndrome. Furthermore, the spoke head can be broken and torn the ligaments of the elbow joint.

Therapy

In general, the fracture of the ulna is surgically stabilized by metal plates in children by intramedullary fixation for exact repositioning. The bands of the spoke may need to be sewn. Immobilization in a cast for three to four weeks following the surgical treatment.

Overlooked radial head

If the deformity of the radial head is not discovered, it comes to healing in the wrong position with Disabilities. Treatment is then considerably more complex, the prognosis depends, among other on the age of the child and the duration of the Luxationsstellung.