Instituzioni Chirrugiche. - frx of proximal ulnar diaphysis with posterior angulation; J Pediatr Orthop. Stitgen A, McCarthy JJ, Nemeth BA, Garrels K, Noonan KJ. head is not promptly reduced; Is Bone Mineral Density Testing Underused in Prostate Cancer Care? Monteggia fractures account for fewer than 5% of forearm fractures, with published literature supporting figures in the range of 1-2%. - bony ankylosis may be more disabling than the joint instability J Orthop Trauma. The posterior interosseous nerve travels around the neck of the radius and dives under the supinator as it courses into the forearm. Evaluation of outcome of corrective ulnar osteotomy with bone grafting and annular ligament reconstruction in neglected monteggia fracture dislocation in children. ROM increased by an average of 30. 2023 Lineage Medical, Inc. All rights reserved, PediatricsMonteggia Fracture - Pediatric. [QxMD MEDLINE Link]. Then divide the underlying padding with scissors (2) and remove the protective strip to expose the skin. Are you sure you want to trigger topic in your Anconeus AI algorithm? [Full Text]. It is the character of the ulnar fracture, rather than the direction of radial head dislocation, that is useful in determining the optimal treatment of Monteggia fractures in both children and adults. (1/8), Level 3 2020 Sep. 40 (8):387-395. [7] Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. Cast treatment with the elbow extended. The other two unsatisfactory results were in a patient who had had a Bado type-I fracture and in one who had had a Bado type-IV fracture. [14]. - realize that even w/ successful closed reduction of the ulna (and accompanying reduction of the radial head) that subsequently It is named after Giovanni Battista Monteggia. This may occur in the field spontaneously or as a result of manipulation by emergency responders. Canton G, Hoxhaj B, Fattori R, Murena L. Annular ligament reconstruction in chronic Monteggia fracture-dislocations in the adult population: indications and surgical technique. LIVIN' ON THE MD EDGE: Drive, Chip, and Putt Your Way to Osteoarthritis Relief, Osteoporosis and Osteopenia: Latest Treatment Recommendations, Osteoporosis: A Bare-Bones Guide to Diagnosis and Treatment. The Monteggia lesion. Bado type II lesion after open reduction and internal fixation. Monteggia Fractures - Trauma - Orthobullets orthoBULLETS MBBULLETSStep 1For 1st and 2nd Year Med Students MBBULLETSStep 2 & 3For 3rd and 4th Year Med Students ORTHOBULLETSOrthopaedic Surgeons & Providers JOIN NOWLOGIN Home Topics Techniques Cards QBank Evidence Cases Videos Podcasts Groups Products Trauma Spine Shoulder & Elbow Knee & Sports Treatment can be isolated closed reduction in the pediatric population (if radiocapitellar joint remains stable). Waters PM. (1/1), Level 4 Pronation injuries of the forearm, with special reference to theanterior Monteggia fracture. The remaining patients had fixation with a plate and screws. [9] and Penrose in 1951 [14]. - key is to obtain length and alignment, which then allows the radial head to be reduced; [Full Text]. Rang's children's fractures. Monteggia lesions in children and adults: an analysis of etiology and long-term results of treatment. Monteggia Fractures in the pediatric population are defined as proximal ulna fractures or plastic deformation of the ulna with an associated radial head dislocation. Unstable (complete) ulnar fractures are prone to residual or recurrent displacement and may require operative fixation. Guitton TG, Ring D, Kloen P. Long-term evaluation of surgically treated anterior monteggia fractures in skeletally mature patients. When the ulna is fractured, energy is transmitted along the interosseous membrane, displacing the proximal radius. A high index of suspicion, therefore, should be maintained with any ulna fracture. Scary Elbows: The Proximal Monteggia with David Stanley | OTS, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, Monteggia Injury: Case of the Week - Joanne Wang, MD, 2016 Current Solutions in Orthopaedic Trauma, Case Presentation: Chronic Monteggia Fx / Ulnar Nonunion. - this ordinarily requires 6-10 wks depending on the age of pt; Stable anatomic reduction of the ulnar fracture results in anatomic reduction of the radial head. Monteggia fracture-dislocation in children. Soni JF, Valenza WR, Pavelec AC. [QxMD MEDLINE Link]. Datta T, Chatterjee N, Pal AK, Das SK. Undecided These injuries are relatively uncommon, accounting for fewer than 5% of all forearm fractures. 1998 Sep;27(9):606-9. - when > 3 months has elapsed, consider non op treatment because bony ankylosis of the elbow may occur following surgery; of flexion for 6 weeks; - Delayed Dx: The Monteggia lesion. Monteggia fractures account for fewer than 5% of forearm fractures, with published literature supporting figures in the range of 1-2%. Ramski, D., Hennrikus, W., Bae, D., et. Bado JL. Richard L Ursone, MD Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, Brooke Army Medical Center Steven I Rabin, MD, FAAOS Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Musculoskeletal Services, Dreyer Medical Clinic [QxMD MEDLINE Link]. (0/1), Level 1 (1/7), Level 1 Conclusions: Monteggia fracture dislocation equiva-lents are rare injuries and pre-surgery recognition by radio-graphs and 3-D CT helps make optimal plan. [QxMD MEDLINE Link]. 2022 Feb 1. (1/8), Undecided 32 (4):352-6. An Alternative to the Traditional Radiocapitellar Line for Pediatric Forearm Radiograph Assessment in Monteggia Fracture. The relatively good results associated with nonoperative treatment of pediatric Monteggia injuries reflect the prevalence of stable (incomplete) fractures in children. 2020 Oct 1. J Am Acad Orthop Surg. Delpont M, Louahem D, Cottalorda J. Monteggia injuries. Subluxation of the radial head occurred in three patients; one patient experienced transient palsy of the posterior interosseous nerve; and distortion of the radial head (which had no bearing on function) occurred in three. 2013 Jan;44(1):59-66. Surgical Management of Missed Pediatric Monteggia Fractures: A Systematic Review and Meta-Analysis. (0/1), Level 2 [7] Interestingly, he described this injury pattern in the pre-Roentgen era solely on the basis of the history of injury and the physical examination findings. hyperextension theory; - Type I (or extension type) - 60% of cases: Are you sure you want to trigger topic in your Anconeus AI algorithm? Stable anatomic reduction of the ulnar fracture results in anatomic reduction of the radial head. The aim of this study was to evaluate clinical outcomes of surgical treatment of Monteggia variant fracture dislocations with focus on the operative technique and management of associated radial head fractures. With careful definition, specific subsets of patients may benefit from consideration as a separate type of Monteggia injury. The keys to successful diagnosis of a Monteggia fracture are clinical suspicion and radiographs of the entire forearm and elbow. (1/1), Level 4 Monteggia GB. 1949 Nov. 31B (4):578-88, illust. (0/7), Level 3 - r/o tear of the annular ligament Are you sure you want to trigger topic in your Anconeus AI algorithm? - recurrent radial head dislocation - type II lesions with posterior dislocations should be maintained in about 70 deg. Steven I Rabin, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Fracture Association, American Orthopaedic Association, AO Foundation, Chicago Metropolitan Trauma Society, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society, Mid-America Orthopaedic Association, Orthopaedic Trauma AssociationDisclosure: Nothing to disclose. - paralysis of deep branch of radial nerve is most common; Six of the eight patients who had an unsatisfactory (fair or poor) result had had a Bado type-II fracture with a concomitant fracture of the radial head. Orthop Clin North Am. The ulna fracture is usually clinically and radiographically apparent. Monteggia lesions in children and adults: an analysis of etiology and long-term results of treatment, Removal of forearm plates. 8 (6):LC01-4. PENROSE JH. Pediatric Monteggia fractures: amulticenter examination of treatment strategy and early clinical and radiographic results. The eponymous term "Monteggia fracture" is most precisely used to refer to dislocation of the proximal radioulnar joint in association with a forearm fracture. At the most recent follow-up examination, which was performed after all of the reoperations and reconstructive procedures had been done, the average score according to the system of Broberg and Morrey was 86 points (range, 15 to 100 points). Monteggia fracture-dislocation is rare in children 2,3,4. Late reconstruction of chronic Monteggia lesions in children can be complicated and unpredictable. The first case is a combined type III Monteggia injury with ipsilateral Type II Salter-Harris injury of the distal end radius fracture with metaphyseal fracture of the Which direction is the radial head most likely dislocated? [Full Text]. Must have high index of suspicion high incidence of missed injuries (Waters, 2010), Appropriate radiographic imaging is essential to making the correct diagnosis, Be aware of plastic deformation of the ulna. 2012 Mar 7. 8 (10):18197-202. - Giovanni Monteggia (1814) first described frx of proximal 1/3 of ulna in association w/ anterior dislocation of radial head; - hence dislocation of radial head w/ frx of proximal 1/3 of ulna is known as Monteggia's deformity. (2/7), Level 4 Complex Monteggia Fractures in the Adult Cohort: Injury and Management. (0/8), Level 2 7th ed. [1] The injury is typically caused by axial loading on a partially flexed metacarpal and may be associated with other carpal bone fractures or ligament injuries. Penrose considered type II lesions a variation of posterior elbow dislocation. This eponym is among the most widely recog nized by orthopaedic surgeons, largely because of the notoriously poor results associated with the treatment of these injuries, particularly in adults83948. - frx of ulna just distal to coronoid process w/ lateral dislocation of radial head; - Type IV (5%) Events Search Events ; All Events List All Events Calendar Trauma Spine Shoulder & Elbow Knee & Sports Pediatrics Recon Hand . Monteggia fractures and their variants are often misdiagnosed, however, because of the numerous atypical presentations of this injury in children. - See: Proximal radius dislocations in skeletally immature teenagers and children occur in the setting of a spectrum of ulnar injuries that often do not follow classic adult patterns. 2012 Feb. 35 (2):138-44. - posterior Monteggia frx is reduced by applying traction to forearm w/ the forearm in full extension; [1] [2] Causes Mechanisms include: Fall outstretched hand with the forearm in excessive pronation (hyper-pronation injury). Vol 2: 520. Once the cast is hardened, mark it, then split using an oscillating saw, a hand saw, or a sharp plaster knife (1). [QxMD MEDLINE Link]. Treatment can be isolated closed reduction in the pediatric population (if radiocapitellar joint remains stable). Li H, Cai QX, Shen PQ, Chen T, Zhang ZM, Zhao L. Posterior interosseous nerve entrapment after Monteggia fracture-dislocation in children. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. The present multicenter retrospective study compared results for the Bouyala procedure with versus without plasty of the annular ligament of the radial head in evolved radial head lesion (Monteggia lesion), assessing the benefit of associating ligamentoplasty to ulnar osteotomy. Removal of forearm plates. [5] The mean arc of forearm rotation increased from 145 to 149. Tan JW, Mu MZ, Liao GJ, Li JM. Ruchelsman DE, Pasqualetto M, Price AE, Grossman JA. The mechanism of injury is most often a fall on an outstretched hand. Nine patients, all of whom had a Bado type-II fracture, needed a reoperation within three months after the initial operation; five had revision of a loose ulnar fixation device, three had resection of the radial head, and one had removal of a wire that had migrated from the radial head into the elbow articulation. J Pediatr Orthop. 2018 Oct. 102 (Suppl 1):93-102. - Plating Techniques Purpose: Monteggia variant defined as Monteggia fracture dislocation with radial head or neck fracture, coronoid fracture, ulnohumeral joint dislocation or combination of these injuries. J Bone Joint Surg Am. Melvin P. Rosenwasser, MD (CSOT #21, 2016), Frontiers in Upper Extremity Surgery - 2016, Monteggia - Alfred W. Hess, MD (Frontiers #16, 2016), Monteggia Fracture Dislocation - Everything You Need To Know - Dr. Nabil Ebraheim. What are floating elbow injuries and how are they treated? J Pediatr Orthop. Musculoskelet Surg. 91 (6):1394-404. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Persistent posterior interosseous nerve palsy associated with a chronic type I Monteggia fracture-dislocation in a child: a case report and review of the literature. Speed JS, Boyd HB: Treatment of fractures of ulna with dislocation of head ofradius (Monteggia fracture). (0/1). Are you sure you want to trigger topic in your Anconeus AI algorithm? Watson-Jones R. Fracture and Joint injuries. [QxMD MEDLINE Link]. 1967 Jan-Feb. 50:71-86. [QxMD MEDLINE Link]. J Clin Diagn Res. - then elbow is gently flexed to > 90 deg to relax biceps; anteriorangulation (usually proximal third); The Monteggia fracture with posterior dislocation of the radial head. 2023 Lineage Medical, Inc. All rights reserved. Surgical management is indicated for radial heads that are not stable following closed reduction. Kevin Strohmeyer, MD Consulting Surgeon, Department of Orthopedic Surgery, Darnall Army Community Hospital, Kevin Strohmeyer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons. Repair of Bado II Monteggia Fracture: Case Presentation and Surgical Technique. (16/80), Level 5 - associated nerve injury: [5] The ulna provides a stable platform for rotation of the radius and forearm. - lateral or anterolateral dislocation of the radial head; J Pediatr Orthop. In a study evaluating long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in 22 children (14 boys, 8 girls; age range, 4 y to 15 y 11 mo), Nakamura et al noted that the postoperative Mayo Elbow Performance Index (MEPI) at follow-up ranged from 65 to 100, with 19 excellent results, two good results, one fair result, and zero poor results. Trauma10531822MonteggiaFracturesAuthor:Tracy JonesIntroductionInjury defined asproximal 1/3 ulnar fracture with associated radial head dislocation/instabilityEpidemiologyrare in adultsmore common in childrenwith peak incidence between 4 and 10 years of agedifferent treatment protocol for childrenAssociated injuriesmay be part of complex injury The ulna and radius are in direct contact with each other only at the PRUJ and the DRUJ; however, they are unified along their entire length by the interosseous membrane. 2009 Jun. Radial head dislocation may lead to radial nerve injury. The records concerning ten consecutive years of experience with Monteggia fractures in adult patients at a level-one trauma center were retrospectively reviewed. 2013. Monteggia described a fracture of the proximal third of the ulna with anterior dislocation of the radial head from both the proximal radioulnar and radiocapitellar joints. 2009 Nov. 34 (9):1618-24. Beutel BG. [QxMD MEDLINE Link]. The fracture of the radial head was treated with either complete or partial excision of the fragments in twelve patients (with replacement with a silicone prosthesis in two), open reduction and internal fixation in ten patients, and no intervention in four patients. Monteggia fractures and their variants are often misdiagnosed, however, because of the numerous atypical presentations of this injury in children. The records concerning ten consecutive years of experience with Monteggia fractures in adult patients at a level-one trauma center were retrospectively reviewed. 1951;33:65-73. You can rate this topic again in 12 months. Galeazzi fracture: Distal radial shaft fracture with associated distal radio-ulnar joint (DRUJ) dislocation Special Investigations Imaging '2 views and 2 joints': Always get a minimum of two views (AP and LAT) that include the joint above and below the injury (two joints). Findings associated with the concomitant radial head dislocation are often subtle and can be overlooked. - achieved w/ forarm in full supination, & longitudinal traction; There were twenty-five women and twenty-three men, and the average age was fifty-two years (range, eighteen to eighty-eight years). (6/78), Undecided He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. - reduction: An ulnar diaphyseal fracture was fixed with an intramedullary Steinmann pin in one patient. - radioulnar synostosis - PIN or radial nerve palsy from anterior displacement of radial head; Baltimore: Williams & Wilkins; 1943. This fracture refers to an intraarticular fracture that separates the palmar ulnar aspect of the first metacarpal base from the remaining first metacarpal. J Bone Joint Surg Br. This is the most common type of Monteggia fracture. plastic deformation of the ulna without obvious fracture, pain, swelling, and deformity about the forearm and elbow, isolated radial head dislocations almost never occur in pediatric patients, a line down the radial shaft should pass through the center of the capitellar ossification center, radial head is stable following reduction, radial head will reduce spontaneously with reduction of the ulna and restoration of ulnar length, for Type I, elbow flexion is the main reduction maneuver, if reduction of radiocapitellar joint is unsuccessful, annular ligament is most common block to reduction, radial head is not stable following reduction, ulnar length is not stable (unable to maintain ulnar length), older patients 10y if closed reduction is not stable, symptomatic individuals (pain, loss of forearm motion, progressive valgus deformity) who had delayed treatment or missed diagnosis, open reduction of radial head through a lateral approach if needed in chronic (>2-3 weeks old) Monteggia fractures where radial head still retains concave structure, annular ligament reconstruction almost never required for acute fractures, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). In addition, there are substantial differences between Monteggia injuries in children and adults. 2020 Aug. 23 (4):233-237. As multiple variants of Monteggia fractures exist, it is most accurately described as a forearm fracture with dislocation of the proximal radioulnar joint.4 Subtle bowing of the ulna shaft with an asssociated radiocapitellar dislocation may be missed by the inexperienced clinician who is looking for a forearm fracture and therefore (OBQ09.264) The ulna was fixed with a tension band-wire construct supplemented with screws in three patients (all of whom had a Bado type-II fracture). The treating physician may reduce an unrecognized dislocation while reducing or immobilizing the ulna fracture. Modified technique for correction of isolated radial head dislocation without apparent ulnar bowing: a retrospective case study. Treatment may be closed reduction and casting for length stable ulna fractures with a stable radiocapitellar joint. - keep elbow flexed ( > 90 deg), to relax biceps, so that full supination can be avoided w/o losing reduction; - Non Operative Treatment: 2015 Nov. 31 (4):565-80. The radius and ulna are closely invested by the interosseous membrane, which accounts for the increased risk of displacement or injury to the radius when the ulna fractures. - see: nerve injuries The eponym Monteggia fracture is most precisely used to refer to a dislocation of the proximal radioulnar joint (PRUJ) in association with a forearm fracture, most commonly a fracture of the ulna. 2022 Jul 22. Anderson LE, Meyer FN. - Discussion: - Type III - 20% Does a Monteggia variant lesion result in a poor functional outcome? The radial head dislocation may not be apparent and will possibly be missed if the elbow is not included in the radiograph. Pathology of the annular ligament in paediatric Monteggia fractures. different treatment protocol for children, may be part of complex injury pattern including, Fracture of the proximal or middle third of the ulna with, Fracture of the ulnar metaphysis (distal to coronoid process) with, Fracture of the proximal or middle third of the, Jupiter Classification of Type II Monteggia Fracture-Dislocations, Fracture extending to distal half of ulna, may or may not be obvious dislocation at radiocapitellar joint, may be loss of ROM at elbow due to dislocation, radial deviation of hand with wrist extension, AP and Lateral of elbow, wrist, and forearm, helpful in fractures involving coronoid, olecranon, and radial head, must ensure stabilty and anatomic alignment of ulna fracture, acute fractures which are open or unstable (long oblique), most Monteggia fractures in adults are treated surgically, ORIF of ulna shaft fracture, open reduction of radial head, failure to reduce radial head with ORIF of ulnar shaft only, Monteggia "variants" with associated radial head fracture, lateral decubitus position with arm over padded support, midline posterior incision placed lateral to tip of olecranon, develop interval between flexor carpi ulnaris and anconeus along ulnar border proximally, and interval between FCU and ECU distally, with proper alignment of ulna radial head usually reduces and open reduction of radial head is rarely needed, failure to align ulna will lead to chronic dislocation of radial head, treatment based on involved components (radial head, coronoid, LCL), if no improvement obtain nerve conduction studies, usually caused by failure to obtain anatomic alignment of ulna, If diagnosis is delayed greater than 2-3 weeks complication rates increase significantly, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. The original description is of a "traumatic lesion distinguished by a fracture of the proximal third of the ulna and an anterior dislocation of the proximal epiphysis of the radius"" [1]. 40 (3):e216-e221. Adults and unstable injuries generally require ORIF of the ulna. Application of this eponym to all injuries with radiocapitellar subluxation or dislocation has led to some confusion. (26/80), Level 4 2. there may be slow and progressive shortening and angulation; It is the character of the ulnar fracture, rather than the direction of radial head dislocation, that is useful in determining the optimal treatment of Monteggia fractures in both children and adults. Problems with the elbow related to fractures of the coronoid process and the radial head, which are common with Bado type-II Monteggia fractures, remain the most challenging elements in the treatment of these injuries. for: Medscape. Monteggia fractures are one third as common as the more familiar Galeazzi fractures. J Bone Joint Surg Am. Forearm fractures in children. [Full Text]. - posterior interosseous nerve may be wrapped around neck of radius, preventing reduction; You are being redirected to 64 (6):857-63. [11, 12] Of the Monteggia fractures, Bado type I has been reported to be the most common (59%), followed by type III (26%), type II (5%), and type IV (1%). J Pediatr Orthop 2015; 35 (2) 115-120. Orthopedics. Zivanovic D, Marjanovic Z, Bojovic N, Djordjevic I, Zecevic M, Budic I. Neglected Monteggia Fractures in Children-A Retrospective Study. 2023 Lineage Medical, Inc. All rights reserved. The Monteggia lesion in children. - in child, a dislocated radial head should never be resected, since it will cause cubitus valgus, prominence of distal end of ulna, Anterior elbow dislocations occur most often as a fracture-dislocation in which the distal humerus is driven through the olecranon, thereby causing a complex, comminuted fracture of the proximal ulna. J Bone Joint Surg Br. Floriano Putigna, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic AssociationDisclosure: Nothing to disclose. Clin Orthop Relat Res. A review of the complications. [QxMD MEDLINE Link]. Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children. Milan: Maspero; 1814. vol 5: Bado JL. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. The posterior interosseous branch of the radial nerve, which courses around the neck of the radius, is especially at risk, particularly in Bado type II injuries. Undecided J Bone Joint Surg Am. Whenever a fracture of a long bone is noted, the joints above and below should be evaluated with radiographs in orthogonal planes (planes at 90 angles to each other). J Am. If you log out, you will be required to enter your username and password the next time you visit. Tan SHS, Low JY, Chen H, Tan JYH, Lim AKS, Hui JH. - angulated ulnar shaft is reduced by firm manual pressure; - Type II (flexion type) - 15% Key words: Monteggia's fracture; Radius fracture; Ulna Since Monteggia first described the fracture bearing his name in 1814, the association of radial head dislocation with ipsilateral ulnar fracture has been well described. Events. 2021 Apr-Jun. Take great care to avoid injury to the underlying skin. 3rd ed. Share cases and questions with Physicians on Medscape consult. Xiao RC, Chan JJ, Cirino CM, Kim JM. Monteggia Fractures in Pediatric and Adult Populations, Clifford R. Wheeless, III, M.D. 1982 Jul. History Mystery: Did Subdural Hematoma Kill Thomas Aquinas? - apex of angular deformity of ulna usually indicates direction of radial head dislocation; - Reduction: [QxMD MEDLINE Link]. Successful Strategies for Managing Monteggia Injuries. Application of this eponym to all injuries with radiocapitellar subluxation or dislocation has led to some confusion. The character of the ulnar fracture is useful in determining optimal treatment. Hume fracture - fracture of the olecranon accompanied by anterior dislocation of the radial head. northampton chronicle and echo obituaries, difference between office visit and outpatient visit,
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