A 23 yo female presents after a motor vehicle collision with only a complaint of right forearm pain.  An x-ray is shown.  What's the diagnosis?

Scroll down for answer

Answer: Monteggia Fracture

• Fracture of the proximal third of the ulna with concurrent dislocation or instability of the radial head
• Mechanism is commonly a FOOSH (fall on an outstretched hand) or a direct blow
• Requires orthopedic consultation, adults typically require operative fixation
• Children occasionally managed non-operatively with long arm splint
• Ulna fracture is often not subtle, but must be diligent to look for radial head displacement (it should point at the capitellum)
• Missed diagnosis of radial head dislocation may lead to chronic pain, ROM deficits, and late complications may include malunion and nerve palsy
• Fun fact:  angle of the ulna fracture will point in the direction of the radial head dislocation

 Tintinalli JE, et al.  Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: McGraw-Hill Education LLC., 2011.