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.