Monteggia Fracture
Fracture of proximal ulnar shaft with radial head dislocation. Remember “MUGR” to recall where the fracture is located. Here’s a quick summary.
• Peak age 4-10
• Ulna fracture will be obvious, avoid being distracted and missing the radial head dislocation; remember, assess the radiocapitellar line
• Mechanism: Fall onto outstretched hand
• Exam: swollen elbow and forearm, limited ROM especially in supination/pronation
• Possible associated injuries: Neuropraxia (posterior interosseous nerve [cannot extend thumb] most common), compartment syndrome, ligamentous injury (LCL)
• ED Management: Pain control
• Splint: Posterior long arm (with supination if types I or Ill)
• Ortho consult: Yes
• Disposition
Types I-IV:
• If stable reduction. DC with orthopedic followup within 1 week
• If unstable. operative repair
• Nonoperative managernent typically only successful in children
Type IV: Operative repair
MH/CCF/CWRU EM Res @MetroHealth_EM
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