Our Summary

This research paper is discussing a specific type of bone break and dislocation that happens in the arm, called a Monteggia fracture-dislocation. This injury involves a break in the upper part of the ulna bone (one of the two long bones in your forearm), along with a displacement of the radial head (the top of the other forearm bone) at the elbow. It’s often caused by falling onto an outstretched hand.

The paper emphasizes the need to carefully check for this kind of injury when someone has broken their ulna, as it’s important not to overlook the accompanying dislocation. If this injury is not treated promptly, it can cause long-term issues. These might include lasting instability in the arm, and osteoarthrosis (a type of arthritis) in the joint formed by the radius and capitate bones in the arm.

FAQs

  1. What is a Monteggia fracture-dislocation and how does it occur?
  2. Why is it important to have a high index of suspicion with ulnar fractures?
  3. What could be the potential long-term outcomes if treatment for a Monteggia fracture-dislocation is delayed?

Doctor’s Tip

One helpful tip a doctor might tell a patient about elbow surgery is to follow post-operative instructions carefully, including completing physical therapy exercises as prescribed. This will help improve range of motion, strength, and overall function of the elbow joint. It is important to communicate any concerns or pain to your healthcare provider so they can adjust your treatment plan accordingly. Additionally, avoiding activities that put excessive stress on the elbow joint during the healing process can help prevent complications and promote successful recovery.

Suitable For

Patients who are typically recommended for elbow surgery for a Monteggia fracture-dislocation include those who have:

  1. A proximal one-third ulna fracture with a concomitant dislocation of the radial head proximally at the elbow
  2. Sustained the injury from a fall on the outstretched hand (FOOSH) low-energy mechanism
  3. A high index of suspicion for a radial head dislocation with any ulnar fractures
  4. Potential for poor long-term outcomes if not treated promptly, such as chronic valgus instability and radiocapitellar osteoarthrosis.

Timeline

Before elbow surgery:

  1. Patient falls on outstretched hand (FOOSH) and experiences pain and swelling in the elbow.
  2. Patient seeks medical attention and undergoes imaging (X-rays, MRI) to diagnose the Monteggia fracture-dislocation.
  3. Orthopedic surgeon recommends surgery to realign the fractured ulna and dislocated radial head.
  4. Patient undergoes pre-operative evaluations and preparations for surgery, including discussing risks and benefits with the surgeon.

After elbow surgery:

  1. Patient undergoes surgery to repair the Monteggia fracture-dislocation, which may involve fixation with plates, screws, or pins.
  2. Patient is monitored in the hospital for pain management and wound care.
  3. Physical therapy begins soon after surgery to regain range of motion and strength in the elbow.
  4. Patient follows a rehabilitation program to gradually increase activity levels and function of the elbow.
  5. Follow-up appointments with the surgeon are scheduled to monitor healing and assess progress.
  6. Long-term follow-up may be necessary to monitor for any complications or issues related to the surgery.

What to Ask Your Doctor

  1. What type of elbow surgery do I need for my Monteggia fracture-dislocation?
  2. What are the potential risks and complications associated with the surgery?
  3. What is the expected recovery time after the surgery?
  4. Will I need physical therapy after the surgery, and if so, for how long?
  5. What kind of restrictions or limitations will I have after the surgery?
  6. How soon can I return to normal activities and work after the surgery?
  7. What kind of pain management options will be available to me during and after the surgery?
  8. What is the success rate of this type of surgery for Monteggia fracture-dislocations?
  9. Are there any alternative treatments or procedures that I should consider?
  10. How often will I need follow-up appointments after the surgery?

Reference

Authors: Ramponi DR. Journal: Adv Emerg Nurs J. 2022 Jan-Mar 01;44(1):29-33. doi: 10.1097/TME.0000000000000389. PMID: 35089278