Elbow and forearm: The Monteggia fracture dislocation

Monteggia fracture-dislocations are defined by the presence of

  1. A fracture of the ulnar shaft
  2. Dislocation of the radio-humeral joint

In reality, the injury is one and the same - the injury plane runs from the ulna fracture site, through the proximal interosseous membrane, and then the radiohumeral joint.

An injury that might have resulted in a second fracture at the radial shaft, produces a dislocation of the radial head instead. The ulnohumeral joint is spared.

Can this fracture be treated with a cast?

I would not.

In children, it is possible to successfully treat Monteggia fractures without surgery.

In adults, without prompt surgical care, this injury will predictably result in a permanently stiff elbow, with lots of pain. The risk-benefit analysis is clearly in favor of surgery for this injury. Surgical treatment is standard in virtually 100% of cases.

What are the risks of this surgery?

  1. As with other cases of general anesthesia, there is a small risk of death, stroke, heart attack, etc.
  2. There is a small risk of infection, approximately 1%.
  3. There is a risk of loss of reduction, breakage or loosening of the screws, etc.
  4. There is a risk of postraumatic elbow arthritis
  5. There is a risk of nerve and vessel damage, usually from the injury itself.

What is the typical recovery?

  1. In the best case scenario, a Monteggia injury can be declared healed in 2 months. Usually recovery takes longer
  2. Physical therapy is usually necessary to obtain full motion and strength after this injury.

Case study

This is an example of a 44 year old male with a Monteggia injury sustained after a fall:

Zooming in at the above picture, I have marked in red the path of the injury.

Here is an xray of the above elbow 3 months after surgical treatment. At this time the patient had zero pain, with full motion both at the elbow and wrist. Healing is occurring by primary intention, with no callus formation.

Below is the x-ray at 1 year, showing a fully healed fracture.