Monteggia fracture & galeazzi fracture by Dr Bipul Borthakur

1. MONTEGGIA FRACTURE
 It denotes fracture of proximal ulna shaft with dislocation of
radial head.
 Commonly seen in children
 MECHANISM OF INJURY:
 Fall on a out-stretched hand with forced forearm pronation or forced
elbow abduction

2. MONTEGGIA FRACTURE
 CLINICAL FEATURES:
 Pain and swelling over the elbow
 External deformity of the forearm
 Bony crepitus and painful range of elbow and forearm movements
 Neurovascular examination – Radial nerve or PIN injury

3. MONTEGGIA FRACTURE
 INVESTIGATIONS:
 Plain radiograph of forearm with
elbow and wrist joint
 Look for alignment of radial head
with the capitellum

4. MONTEGGIA FRACTURE
 BADO CLASSIFICATION:-

5. MONTEGGIA FRACTURE
 TREATMENT:-
 Non-operative – reserved only for the pediatric population
 Closed reduction and casting
 Operative
 Closed reduction of the radial head with restoration of ulnar length is
the rule
 CR or OR with TENS in adolescent age group
 OR with plate fixation in adults
 Physiotherapy – after 1 week if fixation is stable

6. MONTEGGIA FRACTURE
 COMPLICATIONS:-
 Nerve injury – radial or PIN
 Non-union
 Radial head instability – due to non-anatomic reduction of ulna

7. GALEAZZI FRACTURE
 It refers to fracture of diaphysis of radius at the junction of the
middle and distal thirds with associated disruption of the distal
radio-ulnar joint (DRUJ)
 It is a fracture of necessity
 MECHANISM OF INJURY:-
 Fall onto an outstretched hand with forearm pronation
 With forearm in supination – Reverse Galeazzi fracture

8. GALEAZZI FRACTURE
 CLINICAL FEATURES:-
 Pain, swelling and external deformity of the forearm
 Tenderness over the fracture site with crepitus, limited movements of
wrist and forearm
 Pain over the wrist on stressing the DRUJ
 Neurovascular injury is rare

9. GALEAZZI FRACTURE
 INVESTIGATIONS:-
 Plain radiograph of the forearm with elbow
and wrist – anteroposterior and lateral
view
 Radiological signs of DRUJ injury
 Fracture at the base of ulnar styloid
 Widened DRUJ on AP view
 Subluxed ulna on lateral view
 >5mm radial shortening

10. GALEAZZI FRACTURE
 TREATMENT:- Always operative
 Open reduction and internal fixation with TENS
in paediatric patients; plate and screw fixation in
adults
 Unstable DRUJ after radius fixation – K wire
fixation for 6-8 weeks or immobilization in long
arm cast for 4-6 weeks
 Physiotherapy – Early motion if DRUJ is
stable after radius fixation

11. GALEAZZI FRACTURE
 COMPLICATIONS:-
 Early:
 Neurovascular injury is rare; seen in gunshot injuries and iatrogenic
damage to nerves
 Compartment syndrome
 Late:
 Malunion and non-union
 Radioulnar synostosis
 Re-fracture after plate removal