Monteggia Fracture S52.279A 813.03

synonyms:

Monteggia Fracture ICD-10

• S52.271A - Monteggia's fracture of right ulna, initial encounter for closed fracture
• S52.272A - Monteggia's fracture of left ulna, initial encounter for closed fracture
• S52.279A - Monteggia's fracture of unspecified ulna, initial encounter for closed fracture 

Monteggia Fracture CPT 

Monteggia Fracture ICD-9

• 813.03(closed Monteggia's fracture)
• 813.13(open Monteggia's fracture)

Monteggia Fracture Etiology / Epidemiology / Natural History

• Definition: fracture near the head of the ulna with associated dislocation of the radial head.
• Accounts for less than 5 % of all forearm fractures.
• More common in children.
• Adult injuries are typically high energy, fall from heights or MVA.

Monteggia Fracture Anatomy

• See also Elbow anatomy.

Monteggia Fracture Clinical Evaluation

• Pain and swelling in the elbow and ulnar border of the forearm. ROM limited by pain.
• Evaluate Soft Tissue Injury.
• Document NV exam.
• Evaluate for compartment syndrome.
• Document wrist evaluation.

Monteggia Fracture Xray / Diagnositc Tests

• A/P and Lateral forearm views, A/P, lateral elbow films, P/A and lateral wrist views demonstrate radial head dislocation and ulnar shaft fracture.

Monteggia Fracture Classification / Treatment

• Bado
  Type I:  Fracture of the ulnar diaphysis at any level with anterior angulation at the fracture site and an associated anterior dislocation of the radial head.  Treatment: ORIF of the ulna with anatomic reduction.  The radial head generally reduces once the ulna is anatomically reduced, and no surgical treatment to the lateral side is required. If radial does not reduce spontaneously ensure ulnar reduction is anatomic; in ulna is anatomic and radial head is subluxated an open reduction with lateral approach and incision of the annular ligament may be required. 
  Type II:  Fracture of the ulnar diaphysis with posterior angulation at the fracture site and a posterolateral dislocation of the radial head.
• Type III:  Fracture of the ulnar metaphysis with a lateral or anterolateral dislocation of the radial head.
  Type IV:  Fracture of the proximal third of the radius and ulna at the same level with an anterior dislocation of the radial head.  Very difficult to control by closed means.  Require fixation of radius and ulna to provide level arm to reduce radial head.  In young pts this can be done with IM pins in radius and ulna.  Adults = ORIF  (Gibson, JBJS 74B:780;1992)

Monteggia Fracture Associated Injuries / Differential Diagnosis

• Ulnar Shaft Fracture
• Radius and Ulnar Shaft Fracture
• Galeazzi Fracture
• Elbow Dislocation
• Terrible Triad(coronoid fracture, radial head fracture, elbow dislocation)
• Olecranon fracture / dislocation
• Posterolateral rotatory instability
• Radial head fracture
• Coronoid fracture
• Monteggia Fracture

Monteggia Fracture Complications

• Nonunion
• Malunion
• PIN palsy: most common nerve injury, more common with Bado Type II lesions (Jessing P, Acta Orthop Scand 46:601:1975)

Monteggia Fracture Follow-up Care

• (Konrad GG, JBJS 2007:89Br:354).

Monteggia Fracture Review References

• Egol KA and Koval KJ in Fractures in Adults, 6th ed, 2006
• RING D, JBJS 1998;80A:1733 °
• Ring D, Jupiter JB, Waters PM. Monteggia fractures in children and adults. J Am Acad Orthop Surg. 1998 Jul-Aug;6(4):215-24. 
• Bado JL. The Monteggia lesion. Clin Orthop Relat Res. 1967 Jan-Feb;50:71-86
• Rockwood and Green's Fractures in Adults: 2009
• Orthopaedic Knowledge Update: Shoulder and Elbow 3, 2008