What is a Monteggia Fracture-Dislocation?
A Monteggia Fracture-Dislocation is a type of fracture located around the elbow.
It involves a fracture of the ulna (one of the bones of the forearm) and a dislocation of the radius (the other bone in the forearm) at the level of the elbow joint.
It was first described by Italian pathologist Giovanni Monteggia in 1814.
Treatment of a Monteggia Fracture-Dislocation is with surgery to repair the ulna fracture. During the surgery, the radial head will return to its correct position.
This image shows a Monteggia Fracture-Dislocation
Symptoms
Pain at the elbow that may be severe
Swelling around the elbow
Bones appearing ‘out of place’ at the elbow
Bruising around the elbow
Reduced movement at the elbow
Numbness or tingling in the elbow, forearm or hand
Weakness at the elbow, wrist, fingers or thumb
Causes
Usually a Monteggia fracture is caused by falling on an outstretched hand.
It is occasionally caused by direct trauma to the forearm.
Risk Factors
Investigations
The main investigation required is an X-ray. This will show the bony structures in the elbow and forearm and reveal any fractures and/or dislocations that are present. In the case of a Monteggia fracture, it will show a fracture of the ulna bone (in the forearm), and a dislocation of the radius (the other forearm bone) where it meets the elbow.
Complications
Potential complications from a Monteggia fracture are:
- Malunion – this is when the fracture heals in an abnormal way, so that the normal bone structure is disrupted
- Nonunion – this is when the fracture ends don’t knit together, leaving two separate pieces of bone
- Nerve injury – this can result in pain, tingling, numbness or weakness in the forearm or hand. Nerve injuries usually heal over 1-6 months.
- Chronic pain – this is especially so if the fracture doesn’t heal properly, or the dislocation isn’t addressed properly.
- Infection – This is mainly a problem if the injury is treated with an operation, or if the bone has broken through the skin with the initial injury.
Treatment
Most Monteggia fractures are treated with an operation. This is because it is a particularly unstable type of injury that needs to be stabilised with plates, screws or pins. The specific operation that is required depends on where the forearm bone (ulna) has been broken. It is especially important that the dislocation is fixed quickly after the injury has happened. For this reason, if there is a delay in getting to the operating theatre for any reason, the dislocation may be fixed (without fixing the fracture) in the emergency room under sedation.
Certain types of Monteggia fractures, when they occur in children, do not require an operation and can be managed with a cast.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
There is no real way to prevent a Monteggia fracture, because it occurs following trauma.