MONTEGGIA FRACTURE DISLOCATION LECTURE FOR UNDERGRADUATE

1. MOTEGGIAFRACTURE
DISLOCATION
Dr.GAURAV MEHTA
MBBS MS(ORTH) DNB(ORTH) MRCS
Asst. Professor Orthopedics
MBS Hospital & NMCH, KOTA

2. MONTEGGIA FRACTURE
DISLOCATION
Historically described as :
“fracture proximal third of shaft of ulna with
dislocation of radial head”

3. HISTORY
 In 1814 Giovanni Batista Monteggia, a
surgical pathologist and public health
official in Milan, first described
Monteggia fractures. He observed
injuries in cadavers and provided the
description:
 “Traumatic lesion distinguished by a
fracture of the proximal third of the ulna
and an anterior dislocation of the
proximal epiphysis of the radius.”

4. EPIDEMIOLOGY
 Monteggia fractures constitute about 1 to 2%
of forearm fractures.

5. CLASSIFICATION
 Bado's classification * Jose Louis Bado in
1958 divided Monteggia fractures into four types of
true Monteggia lesions.
 Bado also classified certain injuries as
equivalents to the classic or true Monteggia
lesions because of their similar mechanism of
injuries, radiographic pattern, or methods of
treatment.
* Bado JL. The Monteggia lesion. Clin Orthop 1967;50: 71 to 86.

6. BADO’s
Classification

7. BADO’s
Classification
 Type I : Anterior dislocation: The radial head
is dislocated anteriorly and the ulna has a
fracture in the diaphyseal or proximal
metaphyseal area.
 Most common type

8. BADO’s
Classification
 Type II : Posterior dislocation: The
radial head is posterior/posterolaterally
dislocated, the ulna is usually fractured
in the metaphysis.
 Associated with nerve palsy (PIN) and
poor prognosis

9. BADO’s
Classification
 Type III: Lateral dislocation : There is lateral
dislocation of the radial head with a metaphyseal
fracture of the ulna.

10.  Type IV : Anterior dislocation with radius shaft fracture
 : the pattern of injury is the same as with a type I injury,
with the inclusion of a radius shaft fracture below the
level of the ulnar fracture.
BADO’s
Classification

11. Lett’s Classification
 Classified Monteggia fractures in children based on both the
direction of the radial head dislocation and the type of ulnar
fracture.
 The Bado type I class was subdivided into three sub types.
 Type A is anterior bowing of the ulna due toplastic deformation
with anterior dislocation of the radial head.
 Type B includes a greenstick fracture of the ulna,
 type C has a complete ulnar Fracture.

12. Lett’s Classification

13. MECHANISM OF INJURY
 Type I - forced pronation of forearm
 Type II - axial loading of forearm with flexed elbow
 Type III – forced abduction of elbow
 Type IV - Type I mechanism in which radial shaft
additionally fails

14. Clinical Evaluation
 Fusiform swelling around the elbow.
 Painful restriction of movements i.e. elbow flexion ,
extension, pronation and supination.
 Careful neurovascular examination essential
 Radial nerve & posterior interosseous nerve injury common in
Type II fracture pattern

15. RADIOGRAPHIC EVALUATION
 Anteroposterior (AP) and Lateral x-rays of the forearm.
 Radiographs of the joints at either end of the forearm
wrist, particularly the position of the radial head
 Radiocapitellar Relation:
 Best defined by a true lateral view of the elbow.
 A line drawn down the long axis of the radius bisects the
capitellum of the humerus regardless of the degree of flexion
or extension of the elbow.

16. Radio-capitellar relationship

17. MANAGEMENT
NON OPERATIVE
• Reserved for pediatric population

18. MAINTENANCE OF REDUCTION
 Reduction is maintained by above elbow cast in flexion for 6-8
weeks duration.
 The degree of flexion varies depending on the direction of
the radial head dislocation.
 When the radius is in a straight lateral or anterolateral
position, flexion to 110 to 120 degrees improves stability.
 If there is a posterolateral component to the dislocation, a
position of only 70 to 80 degrees of flexion has been
recommended.
 Forearm rotation usually is in supination, which tightens the
interosseous membrane and further stabilizes the reduction.

19. OPERATIVE TREATMENT
MANAGEMENT
 Treatment of choice
 ORIF of ulna fracture with 3*5 mm contoured plate/
intramedullary nailing(less favored) in pediatric population
 Plate applied on tension side
 Closed reduction of radial head is rule once ulnar length
achieved by ORIF
 Failure of closed reduction of radial head may require open
reduction and radio-capitellar pinning
• Post –op posterior elbow splint applied followed by physio

20. 1. Neglected Monteggia Fracture.
2. Non-union : most often seen in Bado type II
3. Nerve Injuries: radial, median, anterior-posterior
interosseus nerve injury either traumatic or iatrogenic
4. Periarticular Ossification.
5. Compartment Syndrome.
6. Radial head instability
COMPLICATIONS