May 2010 Radiology Quiz

This patient is a 29 year Red sox’s fan who presents to the emergency department with the chief complaint of elbow pain.  The patient states he was pushed while trying to fish his baseball cap out of the urinal at Yankee stadium. The following radiograph was taken.

Questions:

1. Describe what you see? Fracture of the ulna
                                         Dislocation of the radial head

   Diagnosis: Monteggia fracture

2. Mechanism if injury?

 Direct blow to the posterior aspect of the ulna
 Fall with the hand and forearm in forceful pronation

3. Define The Bado classification for the above pathology:

 Type I - Fracture of the proximal or middle third of the ulna with anterior dislocation of the radial head

 Type II - Fracture of the proximal or middle third of the ulna with posterior dislocation of the radial head

 Type III - Fracture of the ulnar metaphysis with lateral dislocation of the radial head

 Type IV - Fracture of the proximal or middle third of the ulna and radius with anterior dislocation of the radial head

4. What would be your management for this patient?

 Open reduction and internal fixation is the preferred treatment in adults and is associated with the best outcome. Children can be treated with closed reduction under general anesthesia.

Trivia:  Andy Warhol conceived and photographed the cover of which Rolling Stones album?

  Answer: Sticky Finger

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