Monteggia fracture dislocation is an indirect injury. That means forces causing the fracture are tranmistted rather than direct.
Here is what is thought about forces of these fractures.
Type I injuries occur because of forced pronation of the forearm. this results in fracture of ulna and anterior dislocation of the forearm.
Type II lesions is posterior angulated fracture of the ulna, and a posterior dislocation of the radial head. Type II lesion is thought to be a variation of an elbow dislocation in which the ulnar shaft fails before the medial ligament of the elbow ruptures.
Type III lesions result from abduction force on elbow. When the forearm is insupination, the radial head dislocates posterolaterally. If pronated, the radial head dislocates anterolaterally.
Type IV lesions are considered to be type I lesions with an associated radial shaft fracture.
Traditionally Monteggia fracture dislocations have been treated by closed manipulations and casting. But closed methods are now considered to be satisfactory only in children.
Open reduction and compression-plate fixation of the fracture of the ulna and closed reduction of the radial head dislocation is the preferred treatment in adults.
The good results depend on rigid fixation of the ulna and accurate reduction of the radial head followed by postoperative rehabilitation to restore soft tissue function while maintaining radial head stability.
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