Mechanism of Injury: Axial load directed up the forearm with a slightly flexed elbow.Both the ulnar shaft fracture and radial head dislocation are directed posteriorly.Mechanism of Injury: (1) direct blow to posterior elbow, (2) hyper-pronated force on an outstretched arm, (3) contracted biceps resists forearm extension causing dislocation and followed by impact leading to ulna fracture.Most common type in children accounting for 70% of cases, 15% of cases in adults.The proximal ulna is fractured and radial head dislocation directed anteriorly.These types depend on the direction of the radial head dislocation. Jose Luis Babo classified Monteggia fractures into four types. The radiocapitellar joint primarily stabilizes the proximal forearm while the TFCC predominantly supports the distal forearm. The interosseous membrane is responsible for distributing axial load force to the forearm, 60% to the radiocapitellar joint and 40% to the ulnohumeral joint. The alignment and stability of the radius and ulna originate from three ligamentous structures: the interosseous membrane, the annular ligament, and the TFCC. Proximally, the ulna consists of the coronoid and olecranon. The ulnar head supplements the triangular fibrocartilage complex (TFCC) at the wrist. Distally, the radius connects with the scaphoid and lunate bones of the wrist. The proximal radial head articulates with the capitellum of the humerus (radiocapitellar joint), rotating within the annular ligament during pronation and supination. The osseous forearm is composed of the radius and ulna bones. These risk factors correlate with a bimodal occurrence with the highest incidence occurring in young males (10:10,000) and elderly females (5:10,000).
The most significant risk factors for midshaft forearm fractures include sports (football and wrestling), osteoporosis, and post-menopausal phase. Distal forearm fractures are far more frequent than midshaft forearm fractures, which occur in about 1 to 10 per 10,000 people per year. Monteggia fractures account for approximately 1% to 2% of all forearm fractures. In conjunction with the bimodal distribution, diaphyseal forearm fractures in young males are commonly due to high-energy trauma, for example, falls from height, sports injuries, motor vehicle accidents, and fractures in elderly females are due to low-energy trauma such as a ground level fall.
The energy from the ulnar fracture gets transmitted along the interosseous membrane leading to rupture of the proximal quadrate and annular ligaments, disrupting the radiocapitellar joint. Monteggia fractures most commonly result from a direct blow to the forearm with the elbow extended and forearm in hyperpronation. Monteggia fractures remain difficult to diagnose clinically, and debilitating complications can occur if proper management is not initiated. Technological advances in radiography and fracture research have helped to better define, classify, and guide operative management. Originally described by Giovanni Battista Monteggia in 1814, the Monteggia fracture is a fracture of the proximal ulna associated with a dislocation of the radial head. Forearm fractures can lead to significant short-term and long-term disability, particularly if treated incorrectly. It is designed to help maximize versatility by allowing pronation and supination of the hand. The forearm is a vital structure in the human body that is essential for completing activities of daily living.
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