Last reviewed by Dr. Raj MD on January 12th, 2022.
What is Monteggia fracture?
This medical condition is a fracture of your forearm in which the proximal third of your ulna breaks and the joint with the radial head at the elbow becomes dislocated along with the dislocation of the ulna at your wrist joint. The ulna is a bone in your forearm that is broader near your elbow with the bone tapering at it approaches your wrist. You can find this ulna bone alongside your radius bone on the side of your arm where the pinky finger is located. This type of fracture was first described in the early 1800’s and is named for Giovanni Battista Monteggia, an Italian surgeon. In adults this type of fracture accounts for approximately five percent of forearm fractures. It is more common in children and adolescents.
Monteggia fracture Symptoms
- Arm pain that becomes worse with the movement of your wrist or elbow.
- Swelling of your forearm
- Swelling of your hand
- Swelling of your wrist
- Tenderness in your forearm
- Numbness in your hand
- Your range of motion is limited.
Monteggia fracture Causes
Normally the most common cause of having a Monteggia fracture is falling onto your outstretched hand when you try to break your fall. This is called a hyperpronation injury. There is one uncommon cause of having this type of fracture which is having a direct blow on the back of your upper forearm.
A Monteggia fracture is normally diagnosed by having x-rays taken in order for the doctor to visualize the joints and bones in your arm. The radiographer, the one who takes x-rays, will take x-rays of several angles so the physician can see the full extent of the injury and fracture.
Monteggia fracture Treatment
Exactly what treatment will be used depends on how severe the injury is but the conservative treatment is to put a cast on the arm in order to immobilize the arm while the joint and ulna have an opportunity to heal. After a few weeks of your arm being in the cast the physician will have x-rays taken in order to confirm that the healing is even and the bones are knitting together correctly. If it is shown that the bones have been pulled out of position or they are not healing the physician will take the cast off so the physician can correct the problems. In younger children having a cast put on the fracture will provide enough stability during the healing process so that the fracture will heal properly. Depending on the patient it can take six weeks or longer for the fracture to heal properly and completely.
There is one main concern with this type of fracture is that if the healing in not going as it should be you could end up with the arm with the fracture being shorter than the other arm. It is also possible if the fracture does not heal right that it could make you susceptible to having another fracture which is something that the physician does not want to happen. A big risk with a Monteggia fracture, especially if it an open fracture, is the risk of infection. An open fracture is when the skin has been damaged during the injury or the cartilage or broken bone has immerged through your skin. Another issue that can happen during the healing process is necrosis. This is when the tissue and bone die because they are not being supplied with blood.
Other treatments that may be used include:
- Resting the arm
- Elevation with the arm being higher than your heart.
- Cold compresses but do not get the cast wet. Put an ice pack in a plastic bag and then wrap in a towel so the cast will not become wet.
- Instead of a cast the physician may decide just to splint it.
- Using a shoulder sling.
- Taking either over-the-counter or prescription pain medication.
In adults it is normally necessary to repair the Monteggia fracture with surgery in which the physician will realign the dislocated wrist and repair the broken radius. When surgery is done the surgeon will use pins to repair the ulna and to help stabilize your joint. This surgery will be done by a surgical specialist who is trained to repair injuries and fractures to the bone. After the surgery they will usually put a cast on to provide stability while the fracture heals. Very seldom do children have to have surgery for a Monteggia fracture.