Findings: Fracture of the proximal third of the ulna with associated anterior dislocation of the radial head.
Diagnosis: Monteggia fracture-dislocation (Bado type I).
Bado Classification of Monteggia fractures:
- Type I: Fracture of the proximal third of the ulna with anterior dislocation of the radial head.
- Type II: Fracture of the proximal third of the ulna with posterior dislocation of the radial head.
- Type III: Fracture of the ulnar metaphysis with lateral dislocation of the radial head.
- Type IV: Fracture of the proximal third of both radius and ulna with anterior dislocation of the radial head.
The basis of the Bado classification scheme is that the radial head dislocation is in the direction of the fracture apex.
Treatment:
- Closed reduction and casting should be reserved only for the paediatric population.
- Montegia fractures require operative treatment, with
- Closed reduction of the radial head under anaesthesia.
- Open reduction and internal fixation (ORIF) of the ulna shaft with a 3.5-mm dynamic compression plate (DCP) or reconstruction plate.
The Galeazzi fracture is a related fracture in that it involves a forearm fracture (this time the distal shaft of the radius) and is associated with dislocation of the distal radio-ulnar joint.
