13 year-old right-hand dominant following assault with blunt object. What’s the diagnosis?
Answer
Monteggia Fracture
Ulnar fracture with dislocation of proximal radioulnar joint (often subtle); do not confuse with Galeazzi fracture (radial-shaft fracture with distal radioulnar dislocation)
Interosseous membrane (between radius and ulna) transmits forces to radioulnar joints and causes associated dislocations.
Secondary to fall on outstretched hand with arm in hyper-pronation or with direct trauma to forearm as in defensive wounds (e.g., nightstick injury).Suspected forearm fractures should include Xray of the wrist, forearm, and elbow
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 of associated articular damage and nerve injury.
Radial, ulnar, and median nerve neuropraxias (motor / sensory deficits) may complicate injury.
References
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