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Monteggia Fracture S52.279A 813.03

 

synonyms:

Monteggia Fracture ICD-10

Monteggia Fracture CPT 

Monteggia Fracture ICD-9

  • 813.03(closed Monteggia's fracture)
  • 813.13(open Monteggia's fracture)

Monteggia Fracture Etiology / Epidemiology / Natural History

  • Definition: fracture near the head of the ulna with associated dislocation of the radial head.
  • Accounts for less than 5 % of all forearm fractures.
  • More common in children.
  • Adult injuries are typically high energy, fall from heights or MVA.

Monteggia Fracture Anatomy

Monteggia Fracture Clinical Evaluation

Monteggia Fracture Xray / Diagnositc Tests

Monteggia Fracture Classification / Treatment

  • Bado
    Type I:  Fracture of the ulnar diaphysis at any level with anterior angulation at the fracture site and an associated anterior dislocation of the radial head.  Treatment: ORIF of the ulna with anatomic reduction.  The radial head generally reduces once the ulna is anatomically reduced, and no surgical treatment to the lateral side is required. If radial does not reduce spontaneously ensure ulnar reduction is anatomic; in ulna is anatomic and radial head is subluxated an open reduction with lateral approach and incision of the annular ligament may be required. 
    Type II:  Fracture of the ulnar diaphysis with posterior angulation at the fracture site and a posterolateral dislocation of the radial head.
  • Type III:  Fracture of the ulnar metaphysis with a lateral or anterolateral dislocation of the radial head.
    Type IV:  Fracture of the proximal third of the radius and ulna at the same level with an anterior dislocation of the radial head.  Very difficult to control by closed means.  Require fixation of radius and ulna to provide level arm to reduce radial head.  In young pts this can be done with IM pins in radius and ulna.  Adults = ORIF  (Gibson, JBJS 74B:780;1992)

Monteggia Fracture Associated Injuries / Differential Diagnosis

  • Ulnar Shaft Fracture
  • Radius and Ulnar Shaft Fracture
  • Galeazzi Fracture
  • Elbow Dislocation
  • Terrible Triad(coronoid fracture, radial head fracture, elbow dislocation)
  • Olecranon fracture / dislocation
  • Posterolateral rotatory instability
  • Radial head fracture
  • Coronoid fracture
  • Monteggia Fracture

Monteggia Fracture Complications

  • Nonunion
  • Malunion
  • PIN palsy: most common nerve injury, more common with Bado Type II lesions (Jessing P, Acta Orthop Scand 46:601:1975)

Monteggia Fracture Follow-up Care

  • (Konrad GG, JBJS 2007:89Br:354).

Monteggia Fracture Review References