MONTEGGIA FRACTURES CLASSIFICATIONS

1. MONTEGGIA FRACTURES
CLASSIFICATIONS
(RECENT AND NEGLECTED)
PRESENTED BY:
DR AGGOUN

2. PLAN
 INTRODUTION
 CLINICAL PRESENTATION
 MECHANISM
 DIAGNOSIS
 CLASSIFICATIONS
 NEGLECTED MONTEGGIA FRACTURE
 CONCLUSION
 REFERENCES

3. INTRODUCTION
 A Monteggia fracture is defined as a proximal 1/3
ulna fracture with an associated radial head
dislocation.
 Diagnosis is made with forearm and elbow
radiographs to check for congruency of the
radiocapitellar joint in the setting of an ulna fracture

4. CLINICAL PRESENTATION
 pain and swelling at elbow join
 dislocation at radiocapitellar joint
 should evaluate skin integrity
 elbow dislocation
 neurovascular exam
 radial deviation of hand with wrist extension
 weakness of thumb extension
 weakness of MCP extension
 most likely nerve injury

5.  MECHANISM
Typically, Monteggia fracture-
dislocations occur as the result of a fall
onto an outstretched hand
 DIAGNOSIS
Clinic + X ray (AP and lateral views )

6. BADO CLASSIFICATION
• The most commonly used classification system
for Monteggia fractures
• Four types
• based on :
 the direction of the radial head dislocation
 the presence or absence of associated
fractures.

7. BADO CLASSIFICATION
Type I:
 Most common type (around 60% of
cases)
 Anterior dislocation of the radial head
 Fracture of the proximal or middle
third of the ulna, typically with an
angulation anteriorly (towards the
front)
 most common in children and young
adults

8. BADO CLASSIFICATION
Type II:
 Less common (around 15% of cases)
 Posterior dislocation of the radial
head
 Fracture of the proximal or middle
third of the ulna, typically with an
angulation posteriorly (towards the
back)
 70 to 80% of adult Monteggia
fractures

9. Jupiter Classification of Type II
Monteggia Fracture-Dislocations

10. BADO CLASSIFICATION
Type III:
 Less common (around 20% of
cases)
 Lateral or anterolateral dislocation
of the radial head
 Fracture of the proximal or middle
third of the ulna, typically with an
angulation laterally (towards the
outside)

11. BADO CLASSIFICATION
Type IV:
 Least common (around 5% of cases)
 Fracture of both the ulna and radius, often with
comminution (fragmentation)
 Dislocation of the radial head in any direction

12. BADO CLASSIFICATION
Limitations of the bado classification
 It does not consider the involevement of the proximal
radioulnar joint(PRUJ) which can significantly impact
prognosis and treatment
 It does not account the severity of the fracture or the degree
of angulation and displacement

13. AO CLASSIFICATION
the AO/OTA system offers a more comprehensive
approach by incorporating:
 Fracture morphology
 Mechanism of injury
 Associated injuries (PRUJ)
It doesn't specifically categorize Monteggia fractures
as a separate entity
individual fractures in the ulna and radius
according to their respective anatomical locations.

14. TRILLAT CLASSIFICATION
The Trillat classification focuses on
 associated injuries and complexity of the fracture
pattern
 PROGNOSIS VALUE
 THREE groups

15. TRILLAT CLASSIFICATION
 Group I: all diaphyseal ulnar fractures, whatever the direction
of dislocation of the radial head (anterior, posterior or lateral).
 Group II: all metaphyseal-epiphyseal ulnar fractures, whatever
the direction of dislocation of the radial head.
 Group III: all ulnar fractures in group I or group II which are
associated with damage to the radius or humerus (complete
fracture of the radial head, diaphysis or wrist).

16. TRILLAT CLASSIFICATION
IN PEDIATRIC POPULATION :
type I :
 -Diaphyseal FR of the ulna
 - Ant dislocation of the radial head, producing the typical
MONTEGGIA FR
type II :
 High metaphyseal FR, most often greenwood
 External dislocation of the radial head

17. LETTS CLASSIFICATION(PEDIATRIC)
based both on direction of radial head
dislocation and the type of ulnar fracture

18. NEGLECTED MONTEGGIA FRACTURE
 Defined as the fracture of the proximal ulna associated with radial head
dislocation (RHD) without undergoing any treatment for 4 weeks or more
following injury
Clinical examination
 palpable mass
 a decrease in elbow flexion and forearm pronation and supination
 valgus elbow deformity
 instability of the elbow joint and late (tardy) ulnar palsy
SURGICAL TREATEMENT

19. NEGLECTED MONTEGGIA FRACTURE
 The classifications of moneteggia fractures can be applied to the
neglected fractures also
 The most commonely used is the bado classification
Type I: Anterior angulation of the ulnar fracture with an anterior
dislocation of the radial head
Type II: Posterior angulation of the ulnar fracture with a posterior
dislocation of the radial head
Type III: Angulation of the ulnar fracture in any direction with an
anterolateral dislocation of the radial head.
Type IV: Fracture of both the ulna and radius, with a dislocation of the
radial head in any direction.

20. NEGLECTED MONTEGGIA FRACTURE
 Neglected Monteggia fracture: (a) anterior dislocation of the radial head
with heterotopic ossification visible on a lateral view

21. NEGLECTED MONTEGGIA FRACTURE
 (a) Radial head dislocation (dotted line) and ulnar
angulation (heavy line) left unnoticed on initial X-rays;
(b) chronic radial head dislocation and consolidation
of ulnar fracture after cast removal at 4 weeks

22. CONCLUSION
 Monteggia fractures are a comlex type of elbow injury that can be
classified based on the direction of the radial head dislocation and
the presence of any associated fractures.
 The most common classification system is the bado classification ,
which divides montegia fractures into four types
 The treatement of monteggia fractures depends on the type of
fracture ,the severity of the injury , and the patiens age and health
 The best option for a neglected Monteggia injury is prevention

23. REFERENCES
 https://www.rch.org.au/clinicalguide/guideline_index/fractures/monteggia_
fracturedislocations_emergency_department_setting/
 https://journals.lww.com/md-
journal/fulltext/2021/03120/two_stage_strategy_for_neglected_monteggia.
108.aspx
 [1]. Goyal T, Arora SS, Banerjee S, et al. Neglected Monteggia fracture
dislocations in children: a systematic review. J Pediatr Orthop B
2015;24:191–9
 [3]. Chin K, Kozin SH, Herman M, et al. Pediatric Monteggia fracture-
dislocations: avoiding problems and managing complications. Instr Course
Lect 2016;65:399–407.