Executive Editor: Chris Colton

Authors: Dominik Heim, Shai Luria, Rami Mosheiff, Yoram Weil

Forearm shaft Wedge fracture of the ulna, with dislocation of proximal radioulnar joint (Monteggia)

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Glossary

General considerations

In a Monteggia fracture-dislocation, the ulnar wedge fracture is associated with a dislocation of the radial head at the radiocapitellar joint; the proximal radioulnar joint is also disrupted. In most cases, the radial head dislocates anteriorly, rarely the dislocation is posterior.
In Monteggia fracture-dislocations, anatomical reduction and stable fixation are mandatory. The ulnar fracture must be anatomically reduced in order to ensure accurate reduction of the radial head.
Nonoperative treatment is only undertaken if surgery is not possible.
Intramedullary nailing of forearm fractures is currently limited to pediatric fractures and severe multifragmentary injuries of one or both forearm bones in the presence of devastating soft-tissue damage. Pediatric fractures are not included in this module of AO Surgery Reference. Discussion of nailing in adult forearm shaft fractures is confined to multifragmentary fractures of both bones in adult AO Surgery Reference.
Once operative fixation is achieved, the surgeon must ensure the reduction and stability of the radial head, preferably under image intensification.

External fixation
Indication summary Skill Equipment
A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources

External fixation can be indicated in severely open fractures as means of temporary fixation (with a view to later conversion to internal fixation).

ORIF - Compression Plating
Indication summary Skill Equipment
Treatment of choice Highly experienced and skilled surgeon Simple surgical and imaging resources

In Monteggia fracture-dislocations, anatomical reduction and stable fixation are mandatory. This can only be achieved by surgical means.

*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2013-07-09