Monteggia Fracture

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... 

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... 

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. 

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. 

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. 

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