#paeds #radiology see: [RCH Monteggia fracture dislocation](https://www.rch.org.au/clinicalguide/guideline_index/fractures/Monteggia_fracturedislocations_Emergency_Department_setting/) see also: [[Galeazzi fracture dislocation]], [[Neurovascular assessment]], [[paediatric elbow#Radiocapitellar line (AP and lateral)]] > [!key points] > ==ulnar fracture with radial head dislocation== > > Monteggia fracture-dislocations can be easily missed on x-ray. If an ulna fracture is present, always look for a radial head dislocation. > > **All Monteggia fracture-dislocations require an urgent orthopedic assessment.** Reduction is always required. Delayed or missed diagnosis is the most frequent complication > - mnemonic:: MUGR > - “Monteggio → ulnar fracture; Galezzi → radial fracture” # Clinical assessment - radial pulse -- check for brachial artery injury - radial nerve function -- wrist drop, 1st web space sensation, cannot extend against resistance - median nerve function -- thumb abduction, ok sign, sensation 2nd and 3rd distal fingers - ulnar nerve function - finger ABduction, sensation distal 4th and 5th fingers # Complications - radial head dislocation -- lead to non-union, chronic pain / disability - vascular compromise - nerve compromise -- in particular **radial nerve** ; less commonly posterior interosseous - compartment syndrome - myositis ossificans # Classification ## type I ![[Pasted image 20230825225940.png]] ![[Pasted image 20230825230305.png]] ![[Pasted image 20250622120111.png]] > [!caption] Posterior radio-humeral dislocation # X-ray ![[Pasted image 20230825230048.png]] ![[Pasted image 20230825230059.png]] > The **posterior border** of the ulna also needs to be assessed. it should be straight, NOT bowed. > if it is not straight, it indicates a ==plastic deformation injury== ![[Pasted image 20230825230208.png|normal]] ![[Pasted image 20230825230224.png| plastic deformation of the ulna. note the ulna border is not straight.]] # Examples ## Type I monteggia fracture-dislocation with plastic deformation of ulna ![[Pasted image 20230825230345.png| Type I Monteggia fracture-dislocation. A radial head dislocation is evident as shown by the radiocapitellar line. The line drawn down the shaft of the radius does not pass through the centre of the capitellum. There is plastic deformation of the ulna.]] ## Type III monteggia fracture-dislocation ![[Pasted image 20230825230510.png]] ## Type IV ![[Pasted image 20230825230528.png]] monteggia fracture # Related Questions ## galeazzi fracture - [ ] 4Q: [Forearm Injury](x-devonthink-item://834C484F-DDAA-4819-8DF0-84AE5E70DA1D?page=34) -- [Answer](x-devonthink-item://D46998FE-62E2-4A3A-860D-C32C94B86E42?page=16) -- [prop](x-devonthink-item://834C484F-DDAA-4819-8DF0-84AE5E70DA1D?page=76) ## monteggia fracture - [ ] 8Q: [Forearm Injury](x-devonthink-item://09CFA1A7-00F1-4151-979E-8F3984924D54?page=47) -- [Answer](x-devonthink-item://CF5E9C2B-42F9-4F9C-AC29-877E20134927?page=30) - [ ] 9Q: [Child with Forearm Injury](x-devonthink-item://F0CF1E99-6E8D-4E3C-9C45-046E93F30DBA?page=19) -- [Answer](x-devonthink-item://E437B768-E942-4349-941C-A97410E4E28F?page=14) -- [prop](x-devonthink-item://B3E266DE-B0B2-4F19-9986-B7C6FD455008?page=8)