A high index of suspicion, therefore, should be maintained with any ulna fracture. In essence, high-energy trauma (e.g., a motor vehicle collision) and low-energy trauma (e.g., a fall from a standing position) can result in the described injuries. Bado believed that the type 3 lesion, the result of a direct lateral force on the elbow, was primarily observed in children. Penrose considered type 2 lesions a variation of posterior elbow dislocation. In some cases, a direct blow to the forearm can produce similar injuries.Įvans 6 and Penrose 7 studied the cause of Monteggia fractures on cadavers by stabilizing the humerus in a vise and subjecting different forces to the forearm. If the elbow is flexed, the chance of a type 2 or 3 lesion is greater. Usually a Monteggia fracture is caused by falling on an outstretched hand with forced pronation 5. Incomplete fractures of the ulna and greenstick fractures represent other variants that must be corrected along with the radial head dislocation. Poor recognition of this injury pattern can lead to recurrent or persistent dislocation because the radial head reduction remains unstable until the plastic deformity is corrected. Plastic deformation of the ulna in association with anterior radial head dislocation represents up to 31% of anterior Monteggia lesions.
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