The Monteggia fracture is a special form of forearm fracture. The ulna near the elbow joint is broken and the spinal head at the elbow is dislocated (proximal radial head dislocation). This form of dislocation fracture is rare but often overlooked. Find out everything important about causes, symptoms, diagnosis and therapy of the Monteggia fracture!
Monteggia fracture: description
The Monteggia fracture is a special form of forearm fracture. It is a dislocation fracture, ie a combination of fracture (fracture) and dislocation (dislocation): The shaft of the ulna (one of the two forearm bones) is fractured in the proximal part (proximal = close to the body, ie near the elbow). In addition, the spine head (radius head) is dislocated from its articulated connection with the ulna in the region of the elbow (proximal radioulnar joint).
Monteggia fracture: accompanying injuries
When the spine head is stretched out, the small ring ligament between the spine head and the ulna (ligamentum anulare radii) also tears. Accompanying other injuries may occur, for example, the so-called Olekranonfraktur. This refers to the breakage of the ellenbogenseitigen end of the cubit. The olecranon fracture accounts for more than a third of all cases of elbow fracture (elbow fracture). The term “elbow break” doctors summarize all fractures of the humerus, the ulna or radius near the elbow joint together.
Galeazzi fracture
In addition to the Monteggia fracture, there are other forms of dislocation fracture on the forearm, such as the Galeazzi fracture. Here, too, the shaft of the ulna is broken, but in the distal (distal) area – ie in the direction of the wrist. In addition, in the Galeazzi fracture, the head of the ulna, which is articulated near the wrist with the spine (distal radioulnar joint) dislocated. The Galeazzi fracture is sometimes called the “Reversed Monteggia fracture”.
Both the Galeazzi and Monteggia fractures are named after an Italian surgeon: Riccardo Galeazzi (1866-1952) and Giovanni Battista Monteggia (1762-1815).
Monteggia fracture: frequency
The Monteggia fracture is rare, but is often overlooked: in five to ten percent of cases, it is not detected or misinterpreted as an isolated cuboid fracture (the spinal column dislocation is overlooked).
Monteggia fracture: symptoms
An arm fracture such as the Monteggia fracture causes pain in the fracture area and during movement. The forearm is limited in its mobility and usually has a visible malposition. In some cases there is an open fracture – the fractures of the bone protrude through the skin.
Monteggia fracture: causes and risk factors
A possible cause of a Monteggia fracture is a direct trauma to the edge of the ulna. In other cases, there is an indirect trauma behind it, such as a fall on the outstretched arm while the forearm is turned inwards (inward rotation = pronation).
Monteggia fracture: examinations and diagnosis
If you suspect that you have broken your arm, a doctor for orthopedics and traumatology is the right person to contact. In a detailed conversation, he first inquires about the complaints and the history of the accident (anamnesis). Possible questions are:
- How exactly did the accident happen?
- Does the forearm hurt and is its mobility restricted?
- Did you already have any discomfort in the area of the arm, such as pain, restricted movement or a previous dislocation?
This is followed by a physical examination: the doctor examines the arm, carefully scans it and, among other things, looks for soft tissue damage. He also checks blood circulation, motor skills and sensitivity of the arm.
To secure the diagnosis, the forearm is X-rayed. In order to discover a Monteggia fracture, the elbow must be displayed in two planes. If only the forearm is x-rayed, the dislocation remains undetected – the Monteggia fracture is then treated only as a simple forearm shaft fracture.
Monteggia fracture: treatment
In adults, the Monteggia fracture is always treated surgically. First, the ulna is stabilized by inserting a metal plate on the bone (plate osteosynthesis). As a result, the head of the radius usually refracts itself. The torn ring band is sewn.
For aftertreatment, the arm is immobilized in a plaster rail for some time. As soon as possible, an early-onset treatment will be started at the physiotherapist. The forearm must not be turned in during the first four weeks. The metal implant will be removed after a few months.
Monteggia fracture in children
The Monteggia fracture in children can be treated conservatively, if one can close the radius head closed (ie without surgery) again (reposition) and it remains stable in its position. The child is distracted to close it. By pulling the forearm and turning the forearm out (supination), the doctor returns the head of the radius to its correct position. Then the arm is immobilized in a plaster cast for two weeks. At the end, an X-ray inspection follows. If the closed repositioning of the radial head does not succeed, the restraining must be done in one operation.
Monteggia fracture: disease course and prognosis
The Monteggia fracture should be treated as an emergency: The narrowing of the radius head is easier the earlier this happens. In addition, the early narrowing improves the prognosis.
It is very important that one Monteggia fracture also recognized as such and not misinterpreted as a simple forearm fracture. An untreated radial head dislocation can cause, among other things, movement restrictions and instabilities.