| disease | Fracture of the Upper 1/3 of the Ulna with Dislocation of the Radial Head |
| alias | Ménétrier's Disease, Monteggia Fracture |
In 1914, Italian surgeon Monteggia first reported this type of fracture, hence it is called a Monteggia fracture. It commonly occurs in young adults and children and can be caused by either direct or indirect violence.
bubble_chart Etiology
1. Extension type
is more common and mostly occurs in children. When falling with the elbow joint extended or hyperextended, the forearm supinated, and the palm touching the ground, the body's gravity transmits downward along the humerus, first causing an oblique fracture in the upper 1/3 of the ulna. The residual force pushes the radial head to dislocate anterolaterally, with the fracture end angulating toward the palmar and radial sides. In cases caused by direct violence, the fracture is mostly transverse or comminuted.
2. Flexion type
is more common in adults. With the elbow slightly flexed, the forearm pronated, and the palm touching the ground, the force first causes a transverse or short oblique fracture at a higher plane of the ulna, and the radius dislocates posterolaterally, with the fracture end angulating toward the dorsal and radial sides.
3. Adduction type
mostly occurs in young children. Falling forward with the elbow extended, the forearm pronated, and the upper limb slightly adducted, the force pushes from the inner side of the elbow outward, resulting in a transverse or longitudinal split fracture at the coronoid process of the ulna with minimal displacement, and the radial head dislocates outward.
bubble_chart Clinical Manifestations
Pain and restricted movement in the elbow after trauma. Swelling of the elbow and forearm, with obvious displacement showing angular or depressed deformity in the upper ulna, localized tenderness, and the dislocated radial head palpable on the anterolateral or posterolateral side of the elbow joint. The elbow joint has limited mobility in a semi-flexed position, and the forearm often cannot rotate in the neutral position. Radial nerve injury.
bubble_chart Auxiliary ExaminationThe X-ray should include the elbow joint to avoid misdiagnosis of fistula disease. Pay attention to the anatomical relationship of the humeroradial joint, and if necessary, take an X-ray of the healthy side for comparison. For any fracture in the upper segment of the ulna where the X-ray does not show dislocation of the radial head, it should be treated as such a fracture, because the radial head may sometimes reduce on its own after dislocation.
History of obvious trauma, pain in the affected limb, and limited mobility. X-ray can determine the fracture site and displacement.
bubble_chart Treatment Measures
1. Manual reduction and external fixation
General anesthesia or brachial plexus anesthesia is used. For extension-type reduction, with the elbow flexed at 90° and the forearm in a neutral position, after countertraction, the radial head is pushed toward the ulnar and dorsal sides to achieve reduction. Then, the fracture of the ulna is reduced using the folding technique, followed by fixation with a 90° flexed Gypsum cast for 8–10 weeks. For flexion-type reduction, countertraction is applied with the elbow extended, and the radial head is pushed toward the ulnar and palmar sides for reduction. Then, the fracture of the ulna is reduced, and a long-arm Gypsum cast is applied in a semi-extended elbow position for 6–8 weeks. For adduction-type manual reduction of the radial head, the ulna often reduces spontaneously, and a long-arm Gypsum cast is applied for 4–6 weeks.
2. Open reduction and internal fixation
For cases where manual reduction fails; old fractures where the radial head can still be reduced (within 3–6 weeks), surgical reduction may be performed, with efforts to repair or reconstruct the annular ligament, and internal fixation of the ulna to correct deformity. If the radial head cannot be reduced, it may be excised in adults, while in children, excision can be deferred until adulthood.
After early reduction, observation for 1–3 months is recommended, as most cases recover spontaneously. If recovery does not occur after 3 months, surgical exploration and nerve decompression should be performed.
radial nerve injury
