- See:
Monteggia Fractures in Adults
- Discussion:
- all four types of Monteggia frx dislocation are pertinent to children, including Monteggia equivalents;
- diff dx: Monteggia equivalent (w/ fracture of proximal radius rather than dislocation of the radial head);
- Classification:
-
type I:
- anterior dislocation of the radial head w/ apex anterior angulation of the ulnar frx;
- is most common type of this frx;
-
type II frx:
- posterior dislocation of the radial head w/ posterior angulation of the ulnar frx;
-
type III:
- lateral dislocation of radial head w/ ulnar metaphyseal fracture, usually a greenstick type of frx;
- commonly assoc w/
radial nerve injuries & is 2nd most common type of Monteggia frx (approx 1/4 of lesions);
- frx of ulna may be complete or incomplete (
greenstick frx), w/ bowing of ulna due to plastic deformation;
- occasionally there is persistent ulnar bowing, occurring most often w/ type III lesions;
- this can produce subluxation of radial head w/ subsequent pain;
-
type IV:
- anterior radial head dislocation and fractures of both the proximal radius and ulna;
- Radiographs:
- radial head does not ossify until age 4;
- ultrasound or MRI may be helpful with the diagnosis;
- be sure that radiographs include the distal radius, since upto 24% of these injuries may be associated with
distal frx;
- also remember that the "isolated" ulnar green stick frx may actually represent a Monteggia equivalent lesion in which there has been spontaneous reduction of the radial head;
- Treatment:
- in contrast to adults, most of these injuries are treated closed;
- reduction of the radial head, however, must be confirmed;
- for type I, III, and IV Monteggia injuries, immobilize elbow in 100 deg of flexion w/ forearm fully supinated for 6 weeks;
- for type II injuries, immobilize w/ elbow extended for four weeks;
-
inability to achieve reduction;
- improper position of elbow ( < 110 deg of flexion)
- infolded annular ligament;
- radial head buttonholed thru capsule;
- open reduction is indicated if it is necessary to reduce radial head;
- if reduction of radial head is not maintained, IM fixation of ulna frx;
- Complications:
- misdiagnosis:
- chronic radial head dislocation;
- consider the Bell Tawse procedure (slip of triceps fascia is used to reconstruct the annular ligament);
- ref: The treatment of malunited anterior Monteggia fractures in children.
AJS. Bell-Tawse.
JBJS. Vol 47-B. 1965 p 718-723.
The Monteggia lesion. JL Bado. CORR Vol 50. 1967. p 71-86.
Acute Monteggia lesions in children.
Treatment of the missed Monteggia fracture in the child.
Monteggia fracture-dislocations in children.
Forearm fractures in children. Cast treatment with the elbow extended.
Monteggia-type elbow fractures in childhood.
Fracture of the upper end of the ulna associated with dislocation of the head of the radius in children.
Angular remodeling of midshaft forearm fractures in children.
The Monteggia lesion in children. Fracture of the ulna and dislocation of the radial head.
Monteggia injuries in children.
JJ Wiley and JP Galey.
JBJS. Vol 67(5)-B 1985. p 728-731.
Operative treatment of Monteggia fractures in children.
D Ring and PM Waters.
.
JBJS Vol 78(5)-B. 1996. p .734-739.
The Pediatric Monteggia Fracture.
RM Kay MD and DL Skaggs MD.
. The American Journal of Orhtopaedics. Sep 1998. p 606.
Open Reduction and Annular Ligament Reconstruction With Fascia of the Forearm in Chronic Monteggia Lesions in Children.
