Question

15 year-old right-hand dominant male received a direct blow to the right arm with a hockey stick. What’s the diagnosis?

Answer

Monteggia Fracture

• Ulnar fracture with dislocation of proximal radio-ulnar joint; typically secondary to fall on outstretched hand (with arm in hyper-pronation) or with direct trauma to forearm as in a defensive injury (e.g., "Nightstick" injury).
• Should not be confused with a Galeazzi fracture, a fracture of the radius with distal radio-ulnar dislocation
• Remember the mnemonic GRUM; Galeazzi = Radius fracture / Ulnar fracture = Monteggia
• Children may be treated with closed reduction and immobilization; adults usually require open reduction and internal fixation.
• Radial head dislocations should be reduced within 6-8 hours because they can lead to articular damage and/or nerve injury

References

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