A Monteggia fracture is a painful arm fracture where the ulna bone breaks and the joint with the radial head at the elbow dislocates. It can be caused by hyperextension or a blow to the arm. Treatment involves casting or surgery, and poor healing can lead to complications.
A Monteggia fracture is a fracture of the arm in which the ulna, one of the bones in the forearm, breaks and the joint with the radial head at the elbow will dislocate. This fracture is usually very noticeable because it causes extreme pain and the patient’s range of motion will be limited due to the fracture. It can be diagnosed with the assistance of X-rays to visualize the bones and joints of the arm, with the radiology technician ideally taking several angles so that the full extent of the lesion can be fully visualized.
Hyperextension is a common cause for a Monteggia fracture, as is a blow to the arm. There are several subtypes of Monteggia fracture, differentiated by the precise location of the break and the nature of the dislocation. Treatment for all types is essentially the same, with the doctor making note of the type to ensure the arm is set up correctly and for future reference.
This fracture is named after Giovanni Battista Monteggia, who described it in the early 1800s. Conservative treatment is casting to immobilize the arm while the ulna and joint are given a chance to heal. After the arm has been in a cast for several weeks, x-rays may be taken to confirm that the bones are knitting together and healing is uniform. If the bones are not healing or have been pulled out of position, the cast will need to be removed so the situation can be corrected. For young patients, casts are often sufficient unless the fracture appears problematic.
For a severe Monteggia fracture, surgery may be needed. Surgery may be used to fix the fractured ulna and to stabilize the joint if deemed necessary. This procedure is usually performed by an orthopedic surgeon, a surgical specialist who has received special training to work with bone injuries. After surgery, a cast is usually applied to provide stability during healing, and healing time can take six weeks or more, depending on the patient.
One concern with a Monteggia fracture is that if healing doesn’t go well, the arm could end up shorter than the other arm. It is also possible that poor healing could predispose the patient to another fracture, which is not desirable. Other problems that can emerge during healing include necrosis, in which bone and tissue die off because they are not supplied with blood, along with infection, which is an especially big risk with an open fracture.
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