MANUAL MINORS
A Monteggia fracture-dislocation is a complex forearm injury that involves a fracture of the ulna, typically in the proximal third, combined with a dislocation of the radial head at the elbow joint. This injury is often caused by direct trauma or falls onto an outstretched arm. Symptoms include severe pain in the forearm and elbow, swelling, visible deformity, and difficulty moving the arm. It is a serious injury requiring urgent medical attention.
Diagnosis
Diagnosis is based on a combination of physical examination and radiological studies. Pain, swelling, and often a visible deformity around the elbow are observed. X-rays of the forearm and elbow confirm the ulna fracture and radial head dislocation. In complex cases, a CT scan may be required to plan surgical treatment.
Differential Diagnosis
Condition | Distinctive Characteristics |
|---|---|
Galeazzi fracture | Distal radius fracture with dislocation of the distal radioulnar joint. |
Isolated ulna fracture | Affects only the ulna, without radial head dislocation. |
Elbow fracture-dislocation | Involves elbow structures without ulna fracture or radial head dislocation. |
Fracture of both forearm bones | Fracture of both the radius and ulna, without radial head dislocation. |
Emergency Management
In the emergency setting, management includes immediate immobilisation of the affected arm with a splint or sling to prevent further damage. Analgesics are administered to control pain and reduce inflammation. If there is neurovascular compromise, urgent reduction of the radial head dislocation is necessary. Definitive correction is usually performed in the operating room.
Definitive Treatment
Definitive treatment of Monteggia fracture-dislocation is surgical. The ulna fracture is reduced and stabilised using open reduction and internal fixation with plates and screws. Once the fracture is stabilised, the radial head dislocation is reduced. After surgery, the forearm is temporarily immobilised, and physiotherapy is recommended to restore elbow and forearm mobility.
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