What Is a Monteggia Fracture?

Fractures of the upper third of the ulna combined with the dislocation of the small head of the radius are referred to as Mencius fractures. Meng's fractures mostly occur in young adults and children, and can be caused by direct or indirect violence. In 1914, the Italian surgeon Monteggia first reported this type of fracture, so he called it Mencius fracture.

Basic Information

English name

Monteggia's fracture

Visiting department

orthopedics

Multiple groups

Young adults and children

Common locations

joint

Common causes

Direct or indirect violence

Common symptoms

Swelling, deformity, and pain in the elbow with bone fricatives

Causes of Mons fracture

Most were caused by indirect violence. Divided into 3 types:

Straight type

More common, more children. The elbow joint is straightened or overstretched, and the forearm rotates and the palm touches the ground. The acting force passes down the humerus and causes an oblique fracture of the ulna. The residual violence is transferred to the upper end of the radius, forcing the radial head to break through and slide out of the annular ligament. angle. Adults directly fractured with violent blows, and the fractures were transverse or comminuted.

2. Buckling type

More common in adults. The elbow joint is slightly flexed, and the forearm pronation position touches the palm of the hand. The force first causes a horizontal or short oblique fracture of the higher plane of the ulna.

3.Incoming

Occurs in young children. The elbow joint is straight, the forearm rotates forward, and the upper limbs fall slightly forward. The violence is pushed outward from the elbow, resulting in a transverse or longitudinal split fracture at the ulnar coracoid process, with less displacement, and the radial head Dislocation outward.

Clinical manifestations of Mons fracture

After trauma, the elbow and forearm are swollen, and those with obvious displacement can see ulnar angle or depression deformity. The protruded radial head can be felt before or after the elbow joint. Forearm rotation is restricted. Severe swelling is not clear, and local tenderness is obvious.

Mens fracture examination

X-ray examination: Forearm positive and lateral radiographs can confirm the diagnosis. The elbow joint should be included to avoid missed diagnosis. Pay attention to the anatomical relationship of the humerus and radial joint. If necessary, take a radiograph of the healthy side for comparison. When the upper ulna fractures and the radiograph does not show dislocation of the radial head, attention should be paid to whether or not it is reset after the radial head dislocation.

Diagnosis of Menger fracture

According to the patient's obvious history of trauma, pain in the affected limb, limited mobility, and local tenderness. X-ray film can determine the fracture site and displacement. X-ray film showed at the 1/3 junction of the ulna, and the horizontal or short oblique fractures were not severely smashed. If the ulna fracture is significantly displaced, the radial head will be completely dislocated. Dislocation of the radial head can be seen in anterior and posterior X-rays and ulnar radiographs.

Mons fracture treatment

Because this type of injury has both fractures and dislocations, treatment is complicated. If the two measures cannot be taken into consideration, the prognosis will be poor, and even if the reduction and internal fixation are performed, the effect is often not very satisfactory. Therefore, it is necessary to pay attention to it during treatment. It needs to be handled as appropriate according to the different characteristics of the patient's age and fracture situation. The specific methods and requirements are as follows:

1. Mons fracture in children

Most can be closed reduction. After anesthesia, the affected limb is placed on the upper limb spiral traction frame. Under traction, the operator presses the small radial head with one thumb and the child's wrist with the other, and forces the small radial head while pulling and rotating the forearm. Return to the original position. When the sound of the popping sound is heard, it indicates that it is still acceptable. At this time, the elbow joint of the affected limb can be flexed to 70 ° ~ 80 °, which can reduce the slippage rate of the radial small head. If the radial head is prolapsed backwards, it should be slightly extended and fixed on the upper limb plaster cast. After a few days the swelling subsided and the upper extremity plaster was replaced 1 or 2 times.

2. Mens fracture in adults

Treatment is more complicated.

(1) Double fracture of ulna and radius + dislocation of the small head of the radius In principle, open reduction and internal fixation are adopted, including repair or reconstruction of the circular ligament. Fractures of the ulna and radius should be internally fixed with a triangular needle or a plate screw, and pay attention to the physiological curvature of the ulna and radius .

(2) For other types, they should still be reset and fixed with plaster. The specific requirements are as follows: Anesthesia. Use orthopaedic traction bed as much as possible to operate. Reset the radial head first. After the reduction, the flexion time was 80 ° 90 ° (for those with anterior dislocation), or 110 ° 120 ° (for those with posterior dislocation), and then the ulna was reset. After fluoroscopy or filming shows that the fracture ends are satisfied, immediately perform an upper limb plaster fixation and indwelling a bandage on the inner layer of plaster, and use it when preparing plaster for dissection; pay attention to the shape of plaster. Take the film again, at least it should reach the function alignment, otherwise it needs to be opened and reset. The swelling should be replaced in time, and the filming and review should be performed regularly to prevent relocation. If the technique fails, reduction and internal fixation should be opened as soon as possible.