What's the diagnosis? By Dr. Loran Hatch

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)




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.