Monteggia Fracture-Dislocation

Description

A Monteggia injury is a combination: the ulna (the forearm bone on the pinky side) is broken, and at the same time the top of the radius (the radial head) has slipped out of the elbow joint. Recognizing both parts is the key to a good result.

How it happens (the mechanism)

This usually happens from a fall onto an outstretched hand, often with the forearm twisted. The two forearm bones are tied together at both ends, like a ring. When the ulna breaks or bends, the force has to go somewhere, and it often pushes the top of the radius out of the elbow joint. In children, the ulna may only bend without a clear break line, which makes the injury easy to miss. Putting the ulna back to its normal length and shape usually pulls the radial head back into the joint. Caught early, this is very treatable. Found weeks or months later, it often needs a much bigger operation to rebuild the elbow. That is why every forearm fracture gets a careful look at the elbow.

Symptoms

Pain and swelling at the forearm and elbow, a possible deformity, limited elbow motion, and sometimes numbness or tingling in the hand.

Doctor examination and imaging

The doctor examines the forearm and elbow and checks the hand’s nerves. X-rays of the forearm, elbow, and wrist are essential; the radial head should point directly at the elbow (the capitellum) on every view, which is how the dislocation is caught.

Treatment

Often, setting the ulna back into proper alignment allows the radial head to return to the joint on its own, held in a cast. If the break is unstable, surgery to fix the ulna (and occasionally the joint) provides a reliable result. The elbow is then watched closely to confirm it stays in place.

Recovery and long-term outlook

Treated promptly, these do well. A small number of children have temporary nerve tingling that resolves on its own.

When to call the doctor

Call right away or seek emergency care if pain becomes severe or out of proportion, especially pain when the fingers are gently straightened, or the fingers become numb, pale, blue, or cold, or the cast feels dangerously tight. These can signal dangerous pressure within the arm (compartment syndrome). Also call for fever, worsening swelling, or drainage.

Learn more

OrthoInfo (AAOS), Elbow Fractures in Children: orthoinfo.aaos.org (opens in a new tab)

This information is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. For specific concerns about your child, consult a board-certified, fellowship-trained pediatric orthopaedic surgeon.