Monteggia Fracture

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Introduction

A Monteggia fracture is defined as a long-term one-third ulna fracture with radial head dislocation. The term is named after Giovanni Battista Monteggia Who described it in 1814. The forearm is the vital structure of the body. forearm fractures can lead to significant short-term and long-term disability. The technical advances help to identify these fractures easily and have helped to better define, classify and guide in conservative, operative management and also in rehabilitation.

Anatomy

The forearm consists of a radius and ulna forming two radioulnar joints. Proximally, the radius connects the Capitulum of the humerus and radial the notch of the ulna below. This articulation is called the proximal radioulnar joint. Dis tally radius articulated with scaphoid at its lateral part and medically it connects with the lunate. The ulna proximally connects with the trochlea of the humerus and distally it is articulated with the ulna notch of the radius and with the triangular articulate disc in the wrist. the interosseous membrane connects both bones and it is responsible for distributing axial load force to the forearm.

Mechanism of injury

The most common cause of Monteggia fracture is falling on the outstretched arm with a hyper-pronated forearm. The injury can also result from a direct blow to the forearm with the elbow extended and the forearm in hyper pronation. Fall from height, contact sports injuries motorcycle accidents, and osteoporosis are some of the most common causes of this fracture.

Classification

Jose Louis Bado reviewed Monteggia's original fracture dislocation and further classified it into 4 types. This 0 defines a set of traumatic injuries having in common a Monteggia fracture with the dislocation of the radial head either in anterior, posterior or lateral directions.

Type I:Anterior radial head dislocation and fracture of ulna diaphysis with anterior angulation.

Type II: Posterior or posterolateral radial head dislocation and fracture of ulna diaphysis with posterior angulation.

Type III: lateral or anterolateral radial head dislocation and fracture of ulna metaphysis.

Type IV: Anterior radial head dislocation and fracture of proximal third of ulna and radius.

Examination and Evaluation

The patients usually come with complaints of pain and swelling at the fracture site. An examination starts with the visual inspection of the skin, soft tissue, visible bony deformity, skin lacerations, muscle contusion and neurovascular damage. Gentle palpation can be done to identify the tenderness around the fracture site. Radio graphs are advised. Anteroposterior and lateral views will help to identify the type of fracture. Along with this An x-ray of the distal radioulnar joint and wrist also should be taken to rule out other fractures and injuries

Type IV: anterior radial head dislocation

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