A 50 yo female presents after FOOSH; she fell down a curb and rolled to her left side.  She c/o left arm pain.  The arm is neurovascularly intact.  An x-ray is shown.  What's the diagnosis?  Scroll down for answer.

Answer:  Monteggia Fracture

• Proximal ulnar fracture with a radial head dislocation
• radial head dislocation from rupture of the annular ligament
• Most commonly from fall on an outstretched hand (FOOSH), fall on elbow, direct blow
• Radiocapitellar line on lateral x-ray will be disrupted (a line drawn from center of neck of the radius should intersect the capitellum
• Bado Classification (1-4) is used to describe the direction of radial head dislocation, type 4 is with radius fracture and dislocation in any direction
• Treatment
• immobilize with long arm posterior splint
• surgical reduction of ulnar and radial head+/- intermal fixation of ulna
• Complications
• missed radial head dislocation - irreducible in 2-3 weeks
• Memorization hints
• MU-GR
• Monteggia= Ulnar fx (w/radial head dislocation)
• Galeazzi = Radial fx (w/distal radioulnar dislocation)

References: 

Webley J. Forearm. In: Sherman SC. eds. Simon’s Emergency Orthopedics, 7e New York, NY: McGraw-Hill; 2014.

Delpont M, Louahem D, Cottalorda J. Monteggia injuries. Orthop Traumatol Surg Res. 2019;104(1S):S113-S120.