UMEM Educational Pearls

Title: What's the Diagnosis? Images by UMEM alumni Dr. Joy Kay

Category: Visual Diagnosis

Posted: 10/27/2013 by Haney Mallemat, MD (Updated: 10/28/2013)
Click here to contact Haney Mallemat, MD

15 year-old right-hand dominant male received a direct blow to the right arm with a hockey stick. What’s the diagnosis?

Monteggia Fracture

Ulnar fracture with dislocation of proximal radio-ulnar joint; typically secondary to fall on outstretched hand (with arm in hyper-pronation) or with direct trauma to forearm as in a defensive injury (e.g., "Nightstick" injury).
Should not be confused with a Galeazzi fracture, a fracture of the radius with distal radio-ulnar dislocation
Remember the mnemonic GRUM; Galeazzi = Radius fracture / Ulnar fracture = Monteggia
Children may be treated with closed reduction and immobilization; adults usually require open reduction and internal fixation.
Radial head dislocations should be reduced within 6-8 hours because they can lead to articular damage and/or nerve injury

Follow me on Twitter (@criticalcarenow) or Google+ (+criticalcarenow)