The prognosis is significantly decreased by delayed diagnosis and treatment. Long oblique/ comminuted fracture: open reduction and internal fixation In the pediatric population, treatment depends on the type of ulnar fracture: 7,8īowing/ greenstick fracture: closed reduction of the ulnar bow and casting if reduction of the radial head is not possible, open osteotomy and fixation of the ulna may be requiredĬomplete transverse/short oblique fracture: closed reduction and intramedullary fixation Usually, anatomical reduction of the ulna allows for a closed reduction of the radial head. Types I, III, IV are cast at 110° of flexion, whereas type II is cast at 70° of flexion 4,6. In the pediatric population, isolated closed reduction may be possible. That an apparently isolated ulnar plastic/ greenstick fracture may actually represent a Monteggia-equivalent lesion with spontaneous radial head reductionĪll four types of Monteggia fracture-dislocations (see Bado classification) are typically treated with open reduction and internal fixation of the ulna and radius. That up to 24% of cases are associated with a distal radial fracture The age-dependent normal appearance of the elbow centers of ossification, which could mimic a fracture to the inexperienced eye Regarding pediatric patients, one should take into account: Provided that films of adequate quality are obtained, the ulnar fracture is usually obvious and the radial head dislocation should be readily identifiable. When a forearm fracture is identified, dedicated imaging of both the elbow and the wrist is important and good quality AP and lateral views are essential. Monteggia fractures occur mostly in children (peak incidence at ages 4-10 years) and rarely in adults. The direction of radial head dislocation depends on whether abduction or adduction forces were applied during the fall 1.Īs is usually the case, in everyday practice, describing the fracture-dislocation is far more important than remembering the grade. The Bado classification is used to subdivide the fracture-dislocation into four types which all have different treatment options and prognoses and is based on the principle that the direction in which the apex of the ulnar fracture points is the same direction as the radial head dislocation 3. Typically, Monteggia fracture-dislocations occur as the result of a fall onto an outstretched hand (FOOSH) 4.
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