UMEM Educational Pearls

Category: Visual Diagnosis

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

Posted: 10/27/2013 by Haney Mallemat, MD (Emailed: 10/28/2013) (Updated: 10/28/2013)
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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 GRUMGaleazzi = 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


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