Monteggia fracture-dislocation - Revision history

Rossdonaldson1: /* Evaluation */

2021-11-17T23:53:16Z

Evaluation

← Older revision		Revision as of 23:53, 17 November 2021
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	==Evaluation==		==Evaluation==
			[[File:Monteggia Fracture.jpg\|thumb\|X-ray of Monteggia fracture of right forearm, showing fracture of ulna and dislocation of radius.]]
	*Inspect skin for open fracture		*Inspect skin for open fracture
	*Decreased ROM at elbow may indicate dislocation		*Decreased ROM at elbow may indicate dislocation

Jglee3 at 05:34, 19 March 2018

2018-03-19T05:34:48Z

← Older revision		Revision as of 05:34, 19 March 2018
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	*If splinted and stabilized, can be discharged after consultation with Ortho		*If splinted and stabilized, can be discharged after consultation with Ortho
	*Admit for:		*Admit for:
	**Open fracture		**[[Open fracture]]
	**Signs of neurovascular injury		**Signs of neurovascular injury
	**Concern for compartment syndrome		**Concern for [[compartment syndrome]]
	==Complications==		==Complications==
	*Consider [[open fracture]] (look for puncture wounds)		*Consider [[open fracture]] (look for puncture wounds)

Jglee3 at 16:54, 14 March 2018

2018-03-14T16:54:46Z

← Older revision		Revision as of 16:54, 14 March 2018
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	==Disposition==		==Disposition==
			*If splinted and stabilized, can be discharged after consultation with Ortho
			*Admit for:
			**Open fracture
			**Signs of neurovascular injury
			**Concern for compartment syndrome
	==Complications==		==Complications==
	*Consider [[open fracture]] (look for puncture wounds)		*Consider [[open fracture]] (look for puncture wounds)
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	==References==		==References==
			<ref>Waters PM. Monteggia fracture-dislocation in children. In Rockwood and Wilkins' Fractures in Children, 7th Ed. Beaty JH, Kasser JR (Eds). Lippincott Williams & Wilkins, Philadelphia 2010. p.446-74.</ref>
	<references/>		<references/>

	[[Category:Orthopedics]]		[[Category:Orthopedics]]

Josgood: /* Evaluation */

2017-11-30T19:26:54Z

Evaluation

← Older revision		Revision as of 19:26, 30 November 2017
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	==Evaluation==		==Evaluation==
			*Inspect skin for open fracture
			*Decreased ROM at elbow may indicate dislocation
			*PIN neuropathy most commonly associated (hand deviates radially with wrist extension)
	===Adult Imaging===		===Adult Imaging===
	*Xray: AP, Lateral of elbow, forearm, wrist		*Xray: AP, Lateral of elbow, forearm, wrist

Josgood: /* Background */

2017-11-30T19:20:59Z

Background

← Older revision		Revision as of 19:20, 30 November 2017
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	==Background==		==Background==
	*Common in kids (different treatment for kids)		*Proximal ulna fx with radial head dislocation
			*Common in kids (different treatment for kids); rare in adults
	*FOOSH		*FOOSH
	*Easy to overlook the radial head dislocation (will result in worse outcome)		*Easy to overlook the radial head dislocation (will result in worse outcome)

Rossdonaldson1: /* Pediatric Imaging */

2016-12-19T08:06:41Z

Pediatric Imaging

← Older revision		Revision as of 08:06, 19 December 2016
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	*Xray: AP, Lateral of [[Elbow X-ray (peds)\|elbow]], forearm, wrist		*Xray: AP, Lateral of [[Elbow X-ray (peds)\|elbow]], forearm, wrist
	**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<ref>de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.</ref>		**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<ref>de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.</ref>
	**Radial head dislocation + proximal ulna fracture or plastic deformation of the ulna without obvious fracture		*Findings: Radial head dislocation + proximal ulna fracture or plastic deformation of the ulna without obvious fracture

	==Management==		==Management==

Rossdonaldson1 at 08:06, 19 December 2016

2016-12-19T08:06:21Z

← Older revision		Revision as of 08:06, 19 December 2016
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	*FOOSH		*FOOSH
	*Easy to overlook the radial head dislocation (will result in worse outcome)		*Easy to overlook the radial head dislocation (will result in worse outcome)
	*Pediatric
	**Radial head dislocation + proximal ulna fracture or plastic deformation of the ulna without obvious fracture
	*Adult
	**proximal 1/3 Ulna fracture + radial head dislocation (due to ulna shortening)
	**Radial head can dislocate anterior, posterior, or laterally

	==Clinical Features==		==Clinical Features==
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	*Xray: AP, Lateral of elbow, forearm, wrist		*Xray: AP, Lateral of elbow, forearm, wrist
	*CT scan: Fractures involving coronoid, olecranon, and radial head		*CT scan: Fractures involving coronoid, olecranon, and radial head
			*Findings:
			**proximal 1/3 Ulna fracture + radial head dislocation (due to ulna shortening)
			**Radial head can dislocate anterior, posterior, or laterally

	===Pediatric Imaging===		===Pediatric Imaging===
	*Xray: AP, Lateral of [[Elbow X-ray (peds)\|elbow]], forearm, wrist		*Xray: AP, Lateral of [[Elbow X-ray (peds)\|elbow]], forearm, wrist
	**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<ref>de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.</ref>		**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<ref>de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.</ref>
			**Radial head dislocation + proximal ulna fracture or plastic deformation of the ulna without obvious fracture

	==Management==		==Management==

Rossdonaldson1: /* Complex Associated Injuries */

2016-12-19T07:54:24Z

Complex Associated Injuries

← Older revision		Revision as of 07:54, 19 December 2016
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	*Terrible triad of elbow		*Terrible triad of elbow
	**Coronoid fracture		**Coronoid fracture
	**Radial head fracture		**[[Radial head fracture]]
	**Posterior ~~Elbow Dislocation~~		**Posterior [[elbow dislocation]]
	*Open fracture		*[[Open fracture]]
	*Olecranon fracture-dislocation		*Olecranon fracture-dislocation
	*LCL injury		*LCL injury

Rossdonaldson1: /* Pediatric Imaging */

2016-12-19T07:53:05Z

Pediatric Imaging

← Older revision		Revision as of 07:53, 19 December 2016
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	===Pediatric Imaging===		===Pediatric Imaging===
	*Xray: AP, Lateral of elbow, forearm, wrist		*Xray: AP, Lateral of [[Elbow X-ray (peds)\|elbow]], forearm, wrist
	**~~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<ref>de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.</ref>		**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<ref>de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.</ref>

	==Management==		==Management==

Rossdonaldson1 at 07:52, 19 December 2016

2016-12-19T07:52:22Z

← Older revision		Revision as of 07:52, 19 December 2016
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	*May be associated with radial nerve injury (wrist drop, inability to extend the fingers)		*May be associated with radial nerve injury (wrist drop, inability to extend the fingers)

	==Complex Associated Injuries==		===Complex Associated Injuries===
	*Terrible triad of elbow		*Terrible triad of elbow
	**Coronoid fracture		**Coronoid fracture
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	*LCL injury		*LCL injury

	==Adult Imaging==		==Differential Diagnosis==
			{{Forarm fracture DDX}}

			==Evaluation==
			===Adult Imaging===
	*Xray: AP, Lateral of elbow, forearm, wrist		*Xray: AP, Lateral of elbow, forearm, wrist
	*CT scan: Fractures involving coronoid, olecranon, and radial head		*CT scan: Fractures involving coronoid, olecranon, and radial head

	==Pediatric Imaging==		===Pediatric Imaging===
	*Xray: AP, Lateral of elbow, forearm, wrist		*Xray: AP, Lateral of elbow, forearm, wrist
	**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<ref>de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.</ref>		**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<ref>de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.</ref>

	~~==Differential Diagnosis==~~
	~~{{Forarm fracture DDX}}~~

	==Management==		==Management==
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	*Adults: likely requires ORIF		*Adults: likely requires ORIF
	*Peds: possible long arm cast vs ORIF<ref>de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.</ref>		*Peds: possible long arm cast vs ORIF<ref>de laGarza JF. Monteggia fracture-dislocation in children. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins' Fractures in Children, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:491-527.</ref>

			==Disposition==

	==Complications==		==Complications==
	*Consider open fracture (look for puncture wounds)		*Consider [[open fracture]] (look for puncture wounds)
	*Compartment syndrome		*[[Compartment syndrome]]
	*Posterior Interosseous Neuropathy (PIN) - radial nerve branch; affects ~10% of Monteggia fractures		*Posterior Interosseous Neuropathy (PIN) - radial nerve branch; affects ~10% of Monteggia fractures
	**Purely a motor syndrome resulting in finger drop, and radial wrist deviation on extension.		**Purely a motor syndrome resulting in finger drop, and radial wrist deviation on extension.