Monteggia fracture-dislocation: Difference between revisions
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*xray: AP, lat of elbow, forearm, wrist | *xray: AP, lat of elbow, forearm, wrist | ||
**assess radiocapitellar line on every lateral radiograph of the elbow: a line down the radial shaft should pass through the center of the capitellar ossification center<ref>de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.</ref> | **assess radiocapitellar line on every lateral radiograph of the elbow: a line down the radial shaft should pass through the center of the capitellar ossification center<ref>de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.</ref> | ||
==Differential Diagnosis== | |||
{{Forarm fracture DDX}} | |||
==Management== | ==Management== | ||
Revision as of 21:58, 29 December 2014
Background
- common in kids (different tx for kids)
- FOOSH
- Easy to overlook the radial head dislocation (will result in worse outcome)
- Pediatric
- radial head dislocation + proximal ulna fracture or plastic deformation of the ulna without obvious fracture
- Adult
- proximal 1/3 Ulna fx + radial head dislocation (due to ulna shortening)
- radial head can dislocate anterior, posterior, or laterally
Clinical Features
- Pain/swelling at elbow
- Radial head may be palpable in an anterolateral or posterolateral location
- spontaneous relocation possible: must palpate directly over
- May be associated with radial nerve injury (wrist drop, inability to extend the fingers et cetera)
Complex Associated Injuries
- open fracture
- olecranon fracture-dislocation
- radial head fx
- coronoid fx
- LCL injury
- terrible triad of elbow
Adult Imaging
- xray: AP, lat of elbow, forearm, wrist
- CT scan: fxs involving coronoid, olecranon, and radial head
Pediatric Imaging
- xray: AP, lat of elbow, forearm, wrist
- assess radiocapitellar line on every lateral radiograph of the elbow: a line down the radial shaft should pass through the center of the capitellar ossification center[1]
Differential Diagnosis
Forearm Fracture Types
- Distal radius fractures
- Radia ulna fracture
- Isolated radius fracture (proximal)
- Isolated ulna fracture (i.e. nightstick)
- Monteggia fracture-dislocation
- Galeazzi fracture-dislocation
- Forearm fracture (peds)
Management
- Consult ortho in the ED
- Adults: likely requires ORIF
- Peds: possible long arm cast vs ORIF[2]
Complications
- consider open fracture (look for puncture wounds)
- compartment syndrome
- Posterior Interosseous Neuropathy (PIN) - radial nerve branch; affects ~10% of Monteggia Fxs
- purely a motor syndrome resulting in finger drop, and radial wrist deviation on extension.
- malunion with radial head dislocation
See Also
Source
- ↑ de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.
- ↑ de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.