Monteggia Fracture

What is a Monteggia fracture?

A Monteggia fracture is a type of bone fracture in your forearm (a broken arm). It happens close to your elbow joint, where your two forearm bones meet. Your ulna bone runs down the inner side (thumb side) of your forearm, and your radius bone runs down the outer side (pinky side). When a strong force fractures your ulna near your elbow, it destabilizes the joint, causing the radius bone to dislocate.

It’s important for healthcare providers to recognize a Monteggia fracture because it’s a more complex injury than a typical fracture. It leaves your elbow joint unstable, and it’ll need treatment to heal correctly. If possible, your provider will manually move the bones back into position. But if they can’t do it manually, or you have serious damage to a ligament, blood vessel or nerve, you’ll need surgery.

What’s the difference between a Monteggia fracture and Galeazzi fracture?

A Monteggia fracture is a fracture of your ulna bone near your elbow joint that causes your radius bone to dislocate (elbow dislocation). A Galeazzi fracture is a fracture of your radius near your wrist joint that causes your ulna to dislocate from that joint. A simple mnemonic to remember the difference is FROG: Fractured Radius of Galeazzi. If you remember that, you’ll remember Monteggia is the fractured ulna.

What are the signs and symptoms of a Monteggia fracture?

Most people with a Monteggia fracture complain of elbow pain. You’ll feel the fracture somewhere in the upper third part of your forearm. The area will likely be swollen, and you may or may not be able to see that the bones are out of place. A dislocated radius is also painful. You may notice you have a limited range of motion at your elbow. But sometimes, the radius bone spontaneously moves back into place.

A healthcare provider will also check for signs and symptoms of nerve injury, which may include:

• Numbness or tingling (paresthesia).
• Weakness in your forearm or hand.
• Pain that radiates beyond the fracture.

What nerve can a Monteggia fracture injure?

A Monteggia fracture can injure your radial nerve or median nerve. The most common nerve injury is to a branch of the radial nerve called the posterior interosseous nerve (PIN). Damage to this nerve can make it difficult to extend your fingers and thumb. Most of the time, nerve injury from a Monteggia fracture is mild (neurapraxia) and heals by itself within several months. If it doesn’t, surgery can help.

What causes a Monteggia fracture?

A Monteggia fracture is a traumatic injury. Some of the common causes include:

• Falling onto your outstretched hand.
• Falling from a height onto your elbow.
• A direct blow to the back of your elbow.

How do healthcare providers diagnose a Monteggia fracture?

If you’ve injured your arm, a healthcare provider will begin with a physical examination, then follow up with X-rays. The physical exam gives your provider clues about what to look for on X-rays. The key to recognizing a Monteggia fracture is to take X-rays of both your forearm and your elbow. The forearm series will show the ulnar fracture, and the elbow X-ray series will show the radial head dislocation.

Both the ulnar fracture and the radial dislocation can be subtle and easy to miss. This is especially true in children. The fracture may be so minor that it’s hard to see, or it may be more of a bend than a break. Sometimes, the dislocated radius moves back into place by itself before your healthcare provider can see it. They must check carefully for evidence of a previous dislocation to recognize the Monteggia fracture.

What is the treatment protocol for a Monteggia fracture?

Treatment for a Monteggia fracture differs from a simple fracture because it also involves a joint dislocation. When a bone dislocates from a joint, it stretches or tears the tissues that usually hold it in place. Even after the bone has moved back into place, these tissues will need time to repair. Until they do, the joint remains unstable, and you remain at risk of further tissue damage or another dislocation.

Successful treatment for a Monteggia fracture must:

• Put the ulna bone back into its correct position.
• Put the radius bone back into its correct position.
• Stabilize the bones in the joint until healing is complete.

To accomplish this, healthcare providers usually begin with conservative treatment methods, then resort to surgery if necessary. In practice, most children won’t need surgery, and most adults will. This is because children’s bones and tissues are still growing, so they’re more adjustable and faster to heal. In adult joints, the bones are less likely to correct themselves or stay in the correct position without help.

Treatments include:

• Closed reduction. Reduction means moving the dislocated bone back into the joint. A closed reduction is a manual, nonsurgical adjustment. Healthcare providers will always attempt a closed reduction first, if possible. They do the adjustment while you’re under anesthesia. Afterward, you’ll wear a cast or splint to help hold the bones in place until healing is complete.
• Open reduction and internal fixation. When closed reduction isn’t possible, the alternative is an open (surgical) reduction. Internal fixation means putting all the bones back into their correct positions and holding them there. Sometimes, a surgeon must put your ulna back together before they can reduce your radius. They might also have to treat or remove other damaged tissues.

How long is the recovery from a Monteggia fracture?

Most people can start to return to their normal activities eight to twelve weeks after treatment. Athletes and those with more physically demanding jobs may need a little more time. You may need to wear a cast for six to eight weeks after a closed reduction or three weeks after surgery. After that, you’ll have a few weeks of occupational or physical therapy to restore your flexibility and range of motion.

What is the outlook after treatment for a Monteggia fracture?

With timely diagnosis and treatment, most people recover without major complications. But this is a serious injury and elbow stiffness, persistent pain and weakness aren’t uncommon after treatment. Around 10% have temporary nerve damage, lasting a few months. Monteggia fractures that go undiagnosed and untreated for several weeks are harder to treat effectively and may cause lasting damage.