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.
|A means of temporary fixation for severely open fractures|
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|
|Treatment of choice|
In Monteggia fracture-dislocations, anatomical reduction and stable fixation are mandatory. This can only be achieved by surgical means.
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|