UMEM Educational Pearls

Category: Visual Diagnosis

Title: What's the Diagnosis?

Posted: 10/20/2014 by Haney Mallemat, MD (Updated: 11/4/2014)
Click here to contact Haney Mallemat, MD


13 year-old right-hand dominant following assault with blunt object. What’s the diagnosis?


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.


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