What's the Diagnosis? By Dr. Abby Renko
A 30 yo F presents to the ED w/ an obvious L arm deformity after a possible unwitnessed seizure. The affected extremity is neurovascularly intact, however overlying the area of the deformity you notice a pinpoint region oozing blood. After establishing IV access and administering analgesia, you obtain an XR, which is shown below. What's the diagnosis? (scroll down for answer)
Answer: Open L ulnar fracture w/ Radial Head dislocation (Monteggia fracture!)
- Review of Monteggia vs Galeazzi Fractures
- Types of Monteggia Injuries (Bado Classification)
- Type I- anterior dislocation of radial head (most common)
- Type II- posterior dislocation of radial head
- Type III- lateral dislocation of radial head
- Type IV- dislocation in any direction, with fractures of both ulna and radius
- Reminder for open fractures:
- update tetanus
- antibiotics! (typically cefazolin 1g IV)
- additional wet sterile dressing (under posterior long arm splint)
Tintinalli, JE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill Education LLC, 2016.
Blok B,Cheung DS, Platts-Mills TF. First Aid for the Emergency Medicine Boards. 3rd ed. New York, NY: McGraw-Hill Education, LLC, 2016.
OrthoBullets - Monteggia Fractures and Galeazzi Fractures, accessed online, December 2021.