Introduction Definition radial head dislocation plus proximal ulna fracture or plastic deformation of the ulna without obvious fracture Epidemiology 4 to 10 years of age is peak incidence Treatment differs from adult Monteggia fractures Classification Bado Classification Type I Apex anterior proximal ulna fracture with anterior dislocation of the radial head Type II Apex posterior proximal ulna fracture with posterior dislocation of the radial head Type III Apex lateral proximal ulna fracture with lateral dislocation of the radial head Type IV Fractures of both the radius and ulna at the same level with an anterior dislocation of the radial head (1-11% of cases) Presentation Symptoms pain, swelling, and deformity about the forearm and elbow Physical exam must palpate over radial head with all ulna fractures because spontaneous relocation of radial head is common must examine for plastic deformation of the ulna if there is a presumed isolated radial head dislocation isolated radial head dislocations almost never occur in pediatric patients Imaging Radiographs obtain elbow radiographs for all forearm fractures to evaluate for radial head dislocation assess radiocapitellar line on every lateral radiograph of the elbow a line down the radial shaft should pass through the center of the capitellar ossification center obtain forearm radiographs for all radial head dislocations Treatment Nonoperative closed reduction of ulna and radial head dislocation and long arm casting indications Bado Types I-III with radial head is stable following reduction length stable ulnar fracture pattern reduction technique reduction technique uses traction radial head will reduce spontaneously with reduction of the ulna and restoration of ulnar length for Type I, elbow flexion is the main reduction maneuver immobilization Type I 110° of flexion and full supination to tighten interosseous membrane and relax biceps tendon Type II fulll extension. Type III full extension and valgus mold Operative plating of ulna + reduction of radial head ± annular ligament repair/reconstruction indications Bado Types I-III with radial head is not stable following reduction ulnar length is not stable (unable to maintain ulnar length) acute Bado Type IV open fractures older patients ≥ 10y if closed reduction is not stable technique annular ligament reconstruction almost never required for acute fractures open reduction of radial head through a lateral approach if needed in chronic (>2-3 weeks old) Monteggia fractures where radial head still retains concave structure symptomatic individuals (pain, loss of forearm motion, progressive valgus deformity) who had delayed treatment or missed diagnosis ORIF similar to adult treatment indications closed physes Complications Neurovascular posterior interosseous nerve neurapraxia (10% of acute injuries) almost always spontaneously resolves Delayed or missed diagnosis common when evaluation not performed by an orthopaedic surgeon complication rates and severity increase if diagnosis delayed >2-3 weeks
QUESTIONS 1 of 7 1 2 3 4 5 6 7 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ07.143) A 6-year-old boy fell off the monkey bars 3 months ago and has had pain and decreased elbow motion since his fall. His radiographs are shown in figures A and B. Closed reduction was unsuccessful. What is the most appropriate treatment? Review Topic QID: 804 FIGURES: A B 1 Bracing and early range of motion 3% (21/835) 2 Closed reduction and casting in supination and flexion 8% (70/835) 3 Open reduction internal fixation of medial epicondyle fracture 6% (52/835) 4 Open reduction internal fixation of lateral condyle fracture 10% (84/835) 5 Open reduction of radial head dislocation with casting in supination and flexion 72% (601/835) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 5 (OBQ09.81) A 7-year-old girl falls off of her bike and sustains the injury depicted in Figures A & B. All of the following are indications for surgical management of Monteggia fractures EXCEPT: Review Topic QID: 2894 FIGURES: A B 1 Combined radius and long oblique ulnar fracture and reduced radial head dislocation 5% (137/2493) 2 Incomplete ulnar fracture with lateral radial head dislocation that is successfully reduced 91% (2271/2493) 3 Ulnar communition with ulnar shortening 1% (37/2493) 4 One week post-reduction/casting radiograph showing loss of radial head reduction 1% (14/2493) 5 Long oblique ulnar fracture with irreducible radial head dislocation 1% (18/2493) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 2 (OBQ10.42) A 4-year-old girl sustains a buckle fracture of the ulna and associated radial head dislocation. Closed reduction and immobilization of the arm in 110 degrees of flexion (as swelling allows) and full supination enhances the stability of the injury by which of the following: Review Topic QID: 3130 1 Tightening the interosseous membrane 82% (1675/2053) 2 Tightening the biceps 6% (127/2053) 3 Eliminates plastic deformation 3% (68/2053) 4 Relaxes the pronator quadratus 8% (154/2053) 5 Protects the posterior interosseous nerve 1% (20/2053) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 1 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
Upgrade to View Premium Videos Upgrade to View Premium Videos Monteggia Fracture Dislocation - Amr Abdelgaward, MD Derek Moore Pediatrics - Monteggia Fracture - Pediatric 10/18/2014 1276 views
Chronic Monteggia fracture malunion in a 12yo boy (C2648) Pediatrics - Monteggia Fracture - Pediatric HPI - 12 yo boy presents with Left elbow pain and a history of an ulna shaft fracture 3 years ago. He was treated with closed reduction and casting at the time of the initial injury. The boy's parents report that his arm never looked right after the injury. He continued to have pain in the lateral aspect of his elbow, with an associated prominence anterolaterally. They were advised to wait two years which did not yield significant improvement, so they finally sought treatment elsewhere. The patient presents with his parents with complaints of left elbow pain with movement and inability to participate in sports. The patient is right hand dominant and this is a left-sided injury. Only one XRay is available from the initial injury, which is shown. Three current XRays are shown. Would you order further imaging on this patient? 8/5/2016 309 3 1 Pediatric Radial head dislocation? (C2454) Pediatrics - Monteggia Fracture - Pediatric HPI - Patient presented after a fall from a slide on his left arm. Patient denied any other trauma. Patient's parents think he fell on an outstretched arm. What is the most likely diagnosis? 11/30/2015 776 2 3 chronic radial head dislocation(old moneggia) right elbow (C1496) Pediatrics - Monteggia Fracture - Pediatric HPI - pai and limitation of elbow since 2 years How would you treat this patient 4/27/2013 216 3 15