ORTHOPAEDICS - PAEDIATRICS
MONTEGGIA FRACTURE
Prompt
Response
Proximal ulna fracture, spiral fracture of midshaft of ulna with significant displacement and agnulation
Dislocated radial head (Anterior)
Enlarged anterior fat pad
?splint in situ
= Monteggia fracture/dislocation
Proximal ulna fracture, spiral fracture of midshaft of ulna with significant displacement and agnulation
Dislocated radial head (Anterior)
Enlarged anterior fat pad
?splint in situ
= Monteggia fracture/dislocation
PromptExamination of Monteggia fracture
ResponseRadial pulse gheck for brachial artery injury (may indicate need for immediate reduction)
Signs of compartment syndrome - Firm compartment, Pās
Radial nerve injury - wrist drop, sensation first dorsal webspace
Median nerve function - thumb abduction, sensation lateral palm
Ulnaer nerve - finger abduction, sensation medial hand
Signs of compartment syndrome - Firm compartment, Pās
Radial nerve injury - wrist drop, sensation first dorsal webspace
Median nerve function - thumb abduction, sensation lateral palm
Ulnaer nerve - finger abduction, sensation medial hand
PromptComplications of Montegia fracture
ResponseRadial nerve injury - parasthesia dorsum of hand, wrost drop
Compartment syndrome - refractory pain, generalised parasthesia/numbness
Compound fracture - open wound, bone on show
Compartment syndrome - refractory pain, generalised parasthesia/numbness
Compound fracture - open wound, bone on show
PromptManagement
ResponseAnalgesia
Assess and confirm neurovascular status
Fracture splint - backslab in resting position above elbow
Urgent orthopaedic consultation for ORIF
Discussion with parents about injury and predicted course
This is not one to reduce in resus - off to theatres for some hardware
Assess and confirm neurovascular status
Fracture splint - backslab in resting position above elbow
Urgent orthopaedic consultation for ORIF
Discussion with parents about injury and predicted course
This is not one to reduce in resus - off to theatres for some hardware