Monteggia fracture-dislocation: Difference between revisions
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*May be associated with radial nerve injury (wrist drop, inability to extend the fingers) | *May be associated with radial nerve injury (wrist drop, inability to extend the fingers) | ||
==Complex Associated Injuries== | ===Complex Associated Injuries=== | ||
*Terrible triad of elbow | *Terrible triad of elbow | ||
**Coronoid fracture | **Coronoid fracture | ||
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*LCL injury | *LCL injury | ||
==Adult Imaging== | ==Differential Diagnosis== | ||
{{Forarm fracture DDX}} | |||
==Evaluation== | |||
===Adult Imaging=== | |||
*Xray: AP, Lateral of elbow, forearm, wrist | *Xray: AP, Lateral of elbow, forearm, wrist | ||
*CT scan: Fractures involving coronoid, olecranon, and radial head | *CT scan: Fractures involving coronoid, olecranon, and radial head | ||
==Pediatric Imaging== | ===Pediatric Imaging=== | ||
*Xray: AP, Lateral of elbow, forearm, wrist | *Xray: AP, Lateral 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> | ||
==Management== | ==Management== | ||
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*Adults: likely requires ORIF | *Adults: likely requires ORIF | ||
*Peds: possible long arm cast vs ORIF<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> | *Peds: possible long arm cast vs ORIF<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> | ||
==Disposition== | |||
==Complications== | ==Complications== | ||
*Consider open fracture (look for puncture wounds) | *Consider [[open fracture]] (look for puncture wounds) | ||
*Compartment syndrome | *[[Compartment syndrome]] | ||
*Posterior Interosseous Neuropathy (PIN) - radial nerve branch; affects ~10% of Monteggia fractures | *Posterior Interosseous Neuropathy (PIN) - radial nerve branch; affects ~10% of Monteggia fractures | ||
**Purely a motor syndrome resulting in finger drop, and radial wrist deviation on extension. | **Purely a motor syndrome resulting in finger drop, and radial wrist deviation on extension. | ||
Revision as of 07:52, 19 December 2016
Background
- Common in kids (different treatment 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 fracture + 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)
Complex Associated Injuries
- Terrible triad of elbow
- Coronoid fracture
- Radial head fracture
- Posterior Elbow Dislocation
- Open fracture
- Olecranon fracture-dislocation
- LCL injury
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)
Evaluation
Adult Imaging
- Xray: AP, Lateral of elbow, forearm, wrist
- CT scan: Fractures involving coronoid, olecranon, and radial head
Pediatric Imaging
- Xray: AP, Lateral 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]
Management
- Consult ortho in the ED
- Long arm posterior splint with 90 degrees of elbow flexion and the hand in a neutral position
- Adults: likely requires ORIF
- Peds: possible long arm cast vs ORIF[2]
Disposition
Complications
- Consider open fracture (look for puncture wounds)
- Compartment syndrome
- Posterior Interosseous Neuropathy (PIN) - radial nerve branch; affects ~10% of Monteggia fractures
- Purely a motor syndrome resulting in finger drop, and radial wrist deviation on extension.
- Malunion with radial head dislocation
See Also
References
- ↑ 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.