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) 

References:

• 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.