A Monteggia fracture involves a break in the proximal ulna shaft combined with dislocation of the radial head. It most commonly occurs in children following a fall on an outstretched hand. Treatment involves closed or open reduction of the radial head and restoration of the ulna length, with casting or plating depending on patient age. Complications can include nerve injuries or radial head instability. A Galeazzi fracture is a break of the radius near the middle-distal junction with disruption of the distal radio-ulnar joint. It typically results from a fall onto an outstretched, pronated forearm. Treatment is always surgical via open reduction and internal fixation of the radius and potential K-wiring or

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