Monteggia fracture
Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
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The Monteggia fracture is a special type of forearm fracture. The ulna near the elbow joint is broken and at the same time the head of the spoke at the elbow is dislocated (proximal radial head dislocation). This type of dislocation fracture is rare but is often overlooked. Find out everything you need to know about the causes, symptoms, diagnosis and treatment of the Monteggia fracture!
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. S52
Monteggia fracture: description
The Monteggia fracture is a special type of forearm fracture. It is a dislocation fracture, i.e. a combination of a broken bone (fracture) and dislocation (dislocation): The shaft of the ulna (one of the two forearm bones) is broken in the proximal part (proximal = close to the body), i.e. near the elbow. In addition, the head of the spoke (radius head) is dislocated from its articulated connection with the ulna in the area of the elbow (proximal radioulnar joint).
Monteggia fracture: accompanying injuries
When the head of the spoke is dislocated, the small ring ligament between the head of the spoke and the ulna (ligamentum annulare radii) also tears. Other injuries can also occur, for example the so-called olecranon fracture. This is understood to mean the break of the elbow-side end of the ulna. The olecranon fracture accounts for more than a third of all cases of an elbow fracture (elbow fracture).
Under the term elbow fracture, medical professionals summarize all fractures of the humerus, ulna or radius near the elbow joint.
Vessels that run through the cubital fossa (a muscle-bound pit in the area of the elbow) can be damaged in a Monteggia fracture, which can lead to compartment syndrome.
If the radial nerve is injured, radial paralysis occurs, which is noticeable through paralysis of the extensor muscles of the hand and fingers (drop hand).
Galeazzi fracture
In addition to the Monteggia fracture, there are other forms of dislocation fractures on the forearm, such as the Galeazzi fracture. Here, too, the shaft of the ulna is broken, but in the distal area (away from the body) - i.e. towards the wrist. In addition, in the Galeazzi fracture, the head of the ulna, which is articulated to the radius near the wrist (distal radioulnar joint), is dislocated. The Galeazzi fracture is sometimes called the "Reversed Monteggia fracture".
Both the Galeazzi and Monteggia fractures are named after an Italian surgeon: Riccardo Galeazzi (1866-1952) and Giovanni Battista Monteggia (1762-1815).
Monteggia fracture: incidence
The Monteggia fracture is rare, but is often overlooked: in five to ten percent of cases it is not discovered or is misinterpreted as an isolated fracture of the ulnar (the dislocation of the radial head is overlooked).
Monteggia fracture: symptoms
A broken arm like the Monteggia fracture causes pain in the fracture area and when moving. The forearm is restricted in its mobility and usually has a visible misalignment. In some cases, there is an open fracture - the broken ends stick out through the skin.
Monteggia fracture: causes and risk factors
One possible cause of a Monteggia fracture is direct trauma to the edge of the ulna. In other cases, there is indirect trauma, such as falling on an outstretched arm while the forearm is twisted inward.
Monteggia fracture: examinations and diagnosis
If you suspect you have broken your arm, an orthopedic and trauma surgeon is the right person to talk to. In a detailed conversation, he first inquires about the complaints and the course of the accident (anamnesis). Possible questions are:
- How exactly did the accident happen?
- Does the forearm hurt and is its mobility restricted?
- Have you already had any symptoms in the arm area such as pain, restricted mobility or a previous dislocation?
This is followed by a physical examination: the doctor examines the arm, carefully feels it and, among other things, looks for soft tissue damage. It also checks blood flow, motor skills and sensitivity of the arm.
The forearm is X-rayed to confirm the diagnosis. In order to be able to discover a Monteggia fracture, the elbow must also be mapped in two planes. If only the forearm shaft is X-rayed, the dislocation remains undetected - the Monteggia fracture is then only treated as a simple forearm shaft fracture.
Monteggia fracture: treatment
In adults, a Monteggia fracture is always operated on. First, the surgeon stabilizes the ulna by inserting a metal plate on the bone (plate osteosynthesis). As a result, the radial head usually adjusts itself again. Then the surgeon sews the torn ring band.
For follow-up treatment, the arm is immobilized in a plaster splint for some time. As soon as possible, an early functional treatment is started with the physiotherapist. The forearm must not be turned inwards for the first four weeks. The metal implant is removed again after a few months.
Monteggia fracture in children
The Monteggia fracture in children accounts for about ten percent of all child fractures. It can be treated conservatively if the radial head can be adjusted (repositioned) closed (i.e. without surgery) and it remains stable in its position. The child is distracted for closed adjustment. By pulling the forearm and turning the forearm outwards (supination), the doctor brings the radial head back into its correct position. Then the arm is immobilized in a plaster cast for two weeks. At the end there is an X-ray check.
If the closed repositioning of the radial head is not successful, the adjustment must be carried out in one operation.
Monteggia fracture: disease course and prognosis
The Monteggia fracture should be treated as an emergency: the earlier this happens, the easier it is to straighten the radial head. In addition, the early adjustment improves the prognosis.
It is very important that a Monteggia fracture is recognized as such and not misinterpreted as a simple forearm shaft fracture. An untreated radial head dislocation can, among other things, result in restricted mobility and instabilities.
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