Information on Monteggia Fracture
Bones are important parts of the human body. They mainly, support, protect and allow the body to move. Thus, it would have been impossible to sit, walk, stand, run or basically do anything else that humans can do today. They even produce white blood cells and red blood cells for the body. To prove that they are more useful, they also help store more minerals that the body needs. An adult human body has 206 bones while infants still have 270 bones. With this number of bones in the body, there is really a great probability that one will have a bone fracture. This is the condition wherein a bone sustains a break. Fractures are likely caused by a high impact force, stress, or any other injury caused by accidents like a fall, vehicular accident, collision, and the like. Moreover, there are some fractured arms, hips, wrist, ankle, foot, or other parts of the body that are caused by a disease or medical condition, such as osteoporosis, bone cancer, and many other diseases that affect the bone. There are definitely many types of fracture injuries and one of this is Monteggia fracture.
Monteggia fractures are actually fracture of arms. These are characterized by a broken ulna, a bone that is found on the forearm, and a dislocated radial head joint. This was first described by Giovanni Battista Monteggia in the 1800s hence the fracture is named after him. Monteggia fracture dislocation accounts for five percent of these types of forearm fracture. The usual cause of this fracture is a fall with an outstretched hand. Monteggia fracture in children and adolescents is more common than in adults.
As per the study on the cases of Monteggia fracture dislocation, there are two main causes of this injury. If the person falls and an outstretched arm is used to break that fall, this can result to excessive pronation on the forearm, or what is called as hyperpronation injury, further leading to a Monteggia bone fracture. Another cause would be a direct blow to the forearm, particularly on the upper part of it. This strong blow is also one of the most common causes of Monteggia fractures.
After an accident occurs and an injury is sustained afterwards, the best thing to do is to see a doctor. However, one would see the urgency of the case when certain fracture symptoms are recognized. In the case of Monteggia fracture elbow, these symptoms are pain in the arms that escalates every time the wrist or elbow moves. Other symptoms for broken arm bones are deformity, swelling on the forearm, wrist, and hand, numbness, and forearm tenderness. Thus, even before a fracture diagnosis is conducted, the patient would already have a clue that a fracture has really occurred. However, the diagnosis is still necessary for the doctor to know what should be the right medicines and method should to ebe used to treat Monteggia fracture. This is especially necessary because the classification of this fracture is so varied, with each type requiring different Monteggia fracture treatment.
When it comes to Monteggia fracture treatment, each type needs different treatments. Identifying a fractured Monteggia bone is necessary to get the patient the right treatment. Here are the Bado classification of this fracture:
Type I (Extension Type)
This is the most common type of Monteggia fracture dislocation that accounts for 70 percent of the cases in this fracture. This is characterized by the anterior dislocation of the radial head with ulnar fracture. This fracture Monteggia follows a greenstick pattern. The mechanisms of injury that are said to have caused a type I fracture are:
- Hyperpronation mechanism wherein the ulnar shaft is broken and the radial head is dislocated due to the hyperpronation force caused by a fall on an outstretched arm.
- A direct blow fractures the ulnar diaphysis and causes the radial head to dislocate.
- Hyperextension mechanism is the most accepted injury mechanism proposal. This explains the mechanism of the injury that results to a Monteggia lesion in three phases. It is best to explain this in the case of Monteggia fracture in children. The first phase consists of elbow hyperextension when the child attempts to stop a fall using an outstretched arm. During the second phase, the biceps contract to resist the hyperextension which results to dislocating the radial head. The last phase is when the entire body weight of a fallen child is carried by the forearm causing a greenstick fracture or complete oblique fracture.
The treatment for this kind Monteggia variant fracture does not usually require a surgical procedure. Instead, the treatment usually consists of anatomic reduction. The length of the ulnar fracture will be reduced followed by that of the length of the radial head. Elbow flexion is also done. The fracture cast is used for three weeks above the elbow and another three weeks for casting the part below the elbow. After a week of wearing the cast, an x-ray test is done to check the reduction. If the reduction is not successful, fracture surgery might be necessary.
Type II (Flexion Type)
This is a Monteggia injury that has apex-posterior ulnar angulation found at the olecranon-diaphyseal junction. As with the usual Monteggial fracture classification, the radial head is still dislocated. One way on how to heal this type of fracture closed reduction. This makes use of a longitudinal traction but with the elbow extended. Being a flexion injury, the stability of the ulna is maintained with the use of a cast or race for three weeks.
Type III (Lateral Type)
This type of Monteggia’s fracture is not usually treated with reduction due to how the ulna shaft is bent outside with a dislocated radial head. Nerve injury is one of the complications of this type of fracture. Stress fracture of an extended elbow is usually the cause of a type III Monteggia fracture. Reduction is still done in an attempt to counter the mechanism of injury. Elbow hyperextension is done for the stability of the olecranon. Another way on how to treat Monteggia fracture quick is immobilization. This can help stop the risk of the olecranon from being deformed. A long arm cast is applied to the ulna on the forearm. This type is also called a greenstick injury and needs four weeks of casting.
Type IV (Combined Type)
In this fracture, both the ulna and radial shafts are broken with the radial head dislocated anteriorly. The proposed injury mechanisms of this type are the same as those for type I. Surgery is necessary to hasten the fracture healing time of the affected forearm. For kids, intramedullary wires are used for stabilization. Older kids tend to use plate fixation. Immobilization using cast or braces would need three to four weeks for the lower part and three weeks for the upper part of the elbow.
The treatment that is necessary for this fracture should only be done by an orthopedist and a surgical specialist. Only the doctor can tell just when the Monteggia fracture recovery time will be up. These should be people who are trained on performing a surgery on the bone. This is to ensure the safety of the patient and to make sure that the procedure will work for the pain to be worth taking.
A patient with navicular fracture is exposed to the risk of fracture complications. These risks are also present in Maisonneuve fractures as they are existent for Monteggia injury victims. Like many other nondisplaced fractures that can happen to different bone fractures, the patient should not only be after the treatment of the injury. While the recovery time is something that should be expected to end in a few days or weeks, the complications brought about by the fracture or the surgery also need to be handled. After three months, the restriction of motion on the elbow is usually lifted. One of the complications of this fracture is nerve injury. Other risks that a patient is exposed to are periarticular ossificcation and tardy ulnar palsy. If a patient of navicular fracture, for instance, refuses to get a surgery even if one is recommended by the doctor, a complication would likely occur. This also goes the same for a severe case of nasal fracture.
Rehabilitation only happens after three months when the cast is removed. Rehab is necessary for the muscles to be strong once more. However, the exercises that the patient is about to do should first be consulted with the doctor.