Monteggia

Duman, R. S. Monteggia, L. M. (2006). A neurotrophic model for stress-related mood disorders. Biol. Psychiatry, 59(12), 1116-27. 

Miranda, L.A.S., Henriques, J.A.P., and Monteggia, L.O., A full-scale UASB reactor for treatment of pig and cattle slaughterhouse wastewater with a high oil and grease content, Brazilian Journal of Chemical Engineering, 22 (4), 601-610, 2005. Available at http //www.sieclo.br/scielo.php. 

Powell, C. M., Schoch, S., Monteggia, L. et al. The presynaptic active zone protein RIMla is critical for normal learning and memory. Neuron 42 143-153,2004. 

Nestler E, Barrot M, DiLeone RJ, Eisch AJ, Gold SJ, Monteggia LM (2002a) Neiu-obiology of depression. Neimon 34 13-25... 

Doucette-Stamm L, Monteggia L, Donnelly Roberts D, et al Cloning and sequence of the human a7 nicotinic acetylcholine receptor. Drug Dev Res 30 252-256, 1993... 

Wevers A, Monteggia L, Nowacki S, Bloch W, Schutz U, Lindstrom J, Pereira EE, Eisenberg... 

Inclusion of the wrist and elbow in radiographs of forearm fractures is mandatory to exclude associated injuries to these joints (see Monteggia/Galeazzi). One pitfall in interpreting forearm radiographs is to misdiagnose the nutrient artery as an undisplaced fracture. This vessel maybe visualised on the AP radiograph at the junction of the proximal and middle third of the radius. It has a distal entrance point and runs obliquely in a proximal direction. 

Monteggia Lesions 270 Mechanism 270 Presentation 270 Classification 270 Imaging 270 Management 271... 

The Monteggia lesion is dislocation of the radial head associated with a forearm injury. This should not he confused with the Galeazzi injury which is fracture of the radius and dislocation of the distal radioulnar joint. 

Three mechanisms have been proposed for Monteggia injuries hyperextension of the joint, direct blows and hyperpronation. Most falls onto the outstretched limb occur with the arm pronated and in this position, the ligamentous restraints around the proximal radioulnar joint are most lax, predisposing to dislocation. 

Monteggia injuries occur most frequently between the ages of 5 and 7. Patients will generally complain of forearm and elbow pain. If the ulna is fractured, pain will be maximal in the arm and there may be swelling and deformity. The elbow will also be swollen. In 10%-20% of cases, a neuropraxia of the radial nerve will be present, particularly if the radial head is dislocated laterally or anteriorly. Most of these nerve injuries will recover within 6-9 weeks and intervention is not indicated unless there is no sign of clinical or electromyographic recovery at 6 months. 

The standard classification for Monteggia lesions was described by Bado (1967) ... 

When imaging any long bone injury, it is imperative to include both the joint above and the joint below. Whilst Galeazzi lesions are rare in children, Monteggia lesions are not uncommon. It should also be stressed that the joint must be imaged in two planes. The elbow may look normal on the AP view but dislocation of the radial head is readily appreciated on the lateral projection. A straight line drawn up the shaft of the radius should intersect the capitellum in both AP and lateral views, irrespective of the degree of flexion of the joint (Fig. 18.13). 

Monteggia lesions. The articular surface of the radius is normally concave where it articulates with the capitellum. When the radial head has been dislocated for some time, the head becomes convex. This makes relocation of the joint difficult. Similar appearances may also occur in congenital dislocations of the radial head. In this instance, the dislocation is always posterior and thus confused with type II injuries. 

Fig. 18.13a,b. Type I Monteggia fracture with plastic deformation of the ulna, a AP radiograph shows minimal displacement and dislocation could easily he missed, b Lateral radiograph clearly demonstrates the dislocated radial head... 

Bado JL (1967) The Monteggia lesion. Clin Orthop Relat Res 50 71-86... 

Baumann E (1929) Beitrage zur Kenntnis der Fracturen am Ellenbogengelenk. Bruns Beitr klin Chir 146 1-50 Bell Tawse AJS (1965) The treatment of malunited anterior Monteggia fractures in children. J Bone Joint Surg (Br) 47B 718-723... 

Pan, J B, Monteggia, L M., and Giordano, T. (1993) Altered levels and splicing of the amyloid precursor protein in the adult rat hippocampus after treatment with DMSO or retinoic acid Mol Brain Res. 18, 259-266... 

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