What's the diagnosis? By Dr. Michael Tom
A 23 yo female presents after a motor vehicle collision with only a complaint of right forearm pain. An x-ray is shown. What's the diagnosis?
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Answer: Monteggia Fracture
- Fracture of the proximal third of the ulna with concurrent dislocation or instability of the radial head
- Mechanism is commonly a FOOSH (fall on an outstretched hand) or a direct blow
- Requires orthopedic consultation, adults typically require operative fixation
- Children occasionally managed non-operatively with long arm splint
- Ulna fracture is often not subtle, but must be diligent to look for radial head displacement (it should point at the capitellum)
- Missed diagnosis of radial head dislocation may lead to chronic pain, ROM deficits, and late complications may include malunion and nerve palsy
- Fun fact: angle of the ulna fracture will point in the direction of the radial head dislocation
Tintinalli JE, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: McGraw-Hill Education LLC., 2011.