The Monteggia fracture is a fracture of the forearm bone. Monteggia fractures usually result from falls onto the forearm while the elbow is flexed. In the context of a Monteggia fracture, it is mainly the proximal part of the ulna (medical term ulna) that breaks. In addition, the radial head is dislocated.
What is a Monteggia fracture?
Like the Galeazzi fracture, the Monteggia fracture is a dislocation fracture. This is a fracture in which the forearm is dislocated. The forearm is made up of two bones, the ulna and the radius. While a Galeazzi fracture breaks the radius, a Monteggia fracture breaks the ulna near the elbow joint. See nonprofitdictionary for Keratosis Follicularis Spinulosa Decalvans (abbreviated as KFSD).
Not only does the bone break, but the fragments of the ulna shift against each other. The radial head is usually dislocated anteriorly and laterally. The Monteggia fracture was named after the Milanese surgeon Giovanni Monteggia, who was the first to describe this special type of forearm fracture.
Causes
There are a number of possible reasons for a Monteggia fracture. In most cases, the fracture is the result of an accident in which strong forces act on the bone. Such injuries are often the result of traffic accidents. A Monteggia fracture can also result from a fall on the forearm.
The elbow is usually in a bent position, making it particularly prone to fracture. In many cases, the forearm is probably turned inwards. Monteggia fractures in children usually occur as a result of a fall onto an outstretched arm.
Symptoms, Ailments & Signs
Monteggia fractures can manifest themselves through a variety of signs and symptoms in the patient. In many cases, the disease begins with “falling asleep” and the resulting sensation of tingling at the tip of the middle finger. The complaints are often triggered by one-sided positions of the wrist during certain activities. After a short time, the person feels that the hand is swollen. Pain is felt, which usually extends over the entire hand and sometimes also to the forearm. It is characteristic of Monteggia fractures that the pain occurs preferably at rest, which is why it is particularly noticeable at night.
As the disease progresses, the symptoms of a Monteggia fracture increasingly extend beyond nighttime pain and discomfort. The symptoms are also more pronounced during the day. In connection with this, patients often report a certain clumsiness and a feeling of sudden weakness in the hand. In addition, the sensitivity of the skin on the fingers is reduced more and more. Later, the muscles of the ball of the thumb may even be lost.
Diagnosis & course of disease
The Monteggia fracture is usually diagnosed in the conventional way using X-ray examination. As part of this examination, the forearm and elbow are x-rayed from the side and from the front. In particular, the side view allows conclusions to be drawn as to how far the small spoke head has dislocated. It is important that the elbow is shown in a sufficiently assessable manner, otherwise the diagnosis of the Monteggia fracture is made more difficult.
In small children, the radial head is not yet bony, so that correct centering can be verified by means of an ultrasound examination. For detailed diagnoses, the affected patient must present all complaints, also in relation to various concomitant diseases, such as diabetes mellitus, thyroid dysfunction or previous wrist fractures.
A differential diagnosis is also relevant in order to be able to reliably differentiate the Monteggia fracture from other possible diseases. Here, for example, the presence of compression in the median nerve or carpal tunnel syndrome must be ruled out.
Complications
In most cases, the Monteggia fracture leads to the typical falling asleep of the arm and thus to significant limitations in the patient’s everyday life. The affected region tingles and there is a very uncomfortable feeling. Especially when moving the region, the tingling is not further increased. Pain can also occur when the joint is moved.
If the pain also occurs at night in the form of rest pain, this can lead to sleep disorders and thus to a lack of sleep. The pain usually spreads over the entire hand, so that it can no longer be used easily. As the disease progresses, the Monteggia fracture leads to paralysis and other abnormal sensations that make everyday life difficult for those affected.
Those affected appear clumsy and the affected hand is weak. The sensitivity in the fingers is also greatly reduced. In most cases, the symptoms of the Monteggia fracture can be reconstructed so that the limitations and symptoms disappear completely. As a rule, there are no special restrictions. The affected arm is then dependent on rest and recovery. After the treatment, however, it can be used again in the usual way.
When should you go to the doctor?
A doctor should be consulted if there are complaints and discomfort in the forearm after a fall or accident. Restrictions in the usual movement sequences or general mobility as well as reduced physical resilience of the arm must be presented to a doctor. Pain or sensory disturbances need to be evaluated and treated. You should refrain from taking any painkillers until you have consulted your doctor. Alternatively, complications and side effects can occur that have a negative impact on the general state of health of the person concerned.
Sensitivity disorders in the arm, a feeling of numbness or tingling on the skin and hypersensitivity to touch must be examined and treated. They indicate internal injuries to the nerves, muscles or tendons that need to be clarified. If the arm symptoms spread, you should see a doctor as soon as possible.
A special clue to the presence of the Monteggia fracture is the characteristic rest pain. Those affected complain of an increase in the existing symptoms, especially when the arm is in a relieving position or not moving. Without early treatment, the affected person is at risk of permanent impairment of the muscles in the hand. It is therefore advisable to see a doctor as soon as possible so that comprehensive medical care can be initiated.
Treatment & Therapy
A Monteggia fracture can be treated with different methods, whereby the choice of measures depends on the individual clinical picture. A metal plate can be used to rejoin the two fragments of the cubit. In the first step, the fragments must be put back into their correct position (medical term reposition). If the fracture of the ulna is near the elbow joint, plate osteosynthesis is used.
This can lead to osteosynthesis, whereby the bone structure is restored. For this purpose, the broken bones are reassembled using a plate that is fixed to the bone with screws. The exact repositioning of the fracture in the elbow bone takes place as part of a surgical procedure, which is usually performed under general anesthesia.
In children, the Monteggia fracture is stabilized with intramedullary splints. It may be necessary to sew the bands of the spoke. Following the surgical therapy, the arm is immobilized in a cast for a period of three to four weeks.
A Monteggia fracture can also damage the radial nerve and the vessels in the crook of the arm, which can promote the development of compartment syndrome. This must therefore be subjected to an appropriate treatment.
Outlook & Forecast
A correct and early diagnosis of the Monteggia fracture means, among other things, that the quality of life does not suffer. In contrast, a reduction in life expectancy is not to be expected. In practice, it often happens that the disease is misinterpreted as a forearm fracture. Scientific surveys even assume every tenth case. Improper treatment can lead to complications. Those who do without therapy altogether even risk permanent movement restrictions. According to current medical knowledge, early correction is a guarantee of a favorable prognosis.
The type of fracture also determines the prospects of complete healing. In general, the prospect for an on-axis fracture is good. On the other hand, malpositions of the radial head often lead to instability and hindrances in the movement process. This results in a mixed view. Long-term physiotherapy becomes necessary. If necessary, private and professional changes are to be arranged.
The therapeutic approach depends on the age at diagnosis. In children, conservative treatment is often sufficient. Adults, on the other hand, have to undergo surgery. With increasing age, the prospect of a symptom-free healing of the Monteggia fracture diminishes.
Prevention
Since the Monteggia fracture is a broken bone, risky activities should be avoided or special attention should be paid to one’s own movements and the environment, for example in the context of sporting activities. In sports where falls can occur more frequently, appropriate techniques should be trained to reduce falls.
Aftercare
The stabilization of the Monteggia fracture with metal implants is carried out in a surgical procedure if the radial head cannot be set. For follow-up treatment, the arm is immobilized in a plaster cast. X-ray checks are used to monitor the healing process. Early functional physiotherapy should begin as soon as possible. Light exercises in the shoulders and fingers are also recommended while the forearm is in plaster.
The chances of a symptom-free, complete healing depend on the type and severity of the fracture. In the case of an axial combination fracture, the prognosis is generally favorable. In order to avoid functional restrictions, changes in posture or instability in the case of a Monteggia fracture, intensive physiotherapeutic treatment is necessary.
With professional therapy and individually tailored physiotherapy follow-up treatment, the function of the forearm, wrist and fingers can usually be completely restored after four to six weeks. It is important to avoid overuse from abrupt movements. Complicated Monteggia fractures take six months or longer to heal.
If the radial head is misaligned again and blood vessels are affected or nerves in the muscles and bones are affected, patients suffer from restricted movement, sensory disorders or pain. In addition to targeted physiotherapeutic measures, drug-based pain therapy can be used to relieve the symptoms at the site of the injury or in the vicinity.
You can do that yourself
Depending on the individual clinical picture, those affected can take a number of measures to support the recovery of a Monteggia fracture. Splints are usually used for children. Parents of affected children should pay attention to any misalignments and correct them immediately. The splint must be adjusted regularly as the disease progresses, which is why regular visits to the doctor are indicated.
After the surgical therapy, rest and avoidance of external stimuli such as heat or cold apply. The area around the procedure must be cared for according to the doctor’s instructions to prevent wound healing disorders, infections and other problems. In addition, a doctor should be consulted regularly, who can monitor the healing process. If pain, movement disorders or other complications develop, the doctor must be informed in any case.
Other self-help measures are limited to protecting the affected body part from overexertion and taking preventive measures. People who have had a Monteggia fracture or other broken bones should avoid risky activities and pay special attention to their movements and surroundings when exercising. In sports where there is an increased risk of falling, appropriate techniques should be trained to cushion any falls.
