What's the diagnosis? By Dr. Loran Hatch
A 50 yo female presents after FOOSH; she fell down a curb and rolled to her left side. She c/o left arm pain. The arm is neurovascularly intact. An x-ray is shown. What's the diagnosis? Scroll down for answer.
Answer: Monteggia Fracture
- Proximal ulnar fracture with a radial head dislocation
- radial head dislocation from rupture of the annular ligament
- Most commonly from fall on an outstretched hand (FOOSH), fall on elbow, direct blow
- Radiocapitellar line on lateral x-ray will be disrupted (a line drawn from center of neck of the radius should intersect the capitellum
- Bado Classification (1-4) is used to describe the direction of radial head dislocation, type 4 is with radius fracture and dislocation in any direction
- immobilize with long arm posterior splint
- surgical reduction of ulnar and radial head+/- intermal fixation of ulna
- missed radial head dislocation - irreducible in 2-3 weeks
- Memorization hints
- Monteggia= Ulnar fx (w/radial head dislocation)
- Galeazzi = Radial fx (w/distal radioulnar dislocation)
Webley J. Forearm. In: Sherman SC. eds. Simon’s Emergency Orthopedics, 7e New York, NY: McGraw-Hill; 2014.
Delpont M, Louahem D, Cottalorda J. Monteggia injuries. Orthop Traumatol Surg Res. 2019;104(1S):S113-S120.