Musculoskeletal case studies for medical students

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History A 26 year old male was assaulted. The fracture was closed. Neurovascular intact, no other injuries.
Initial X ray
Description AP X ray
X ray
Description Lateral X ray
Problem The 26 year old male who was assaulted. How this was treated, and why.
X ray after treatment
Description Lateral X ray after ORIF
Post management further view
Classification There is displaced and angulated fracture of the midshaft of the ulna. Note that the radial head is subluxed slightly, although not disloacred from the capetellum. A line drawn down the middle of the radial shaft on both the AP and Lateral views should go through the middle of the capetellum. This is an unstable fracture that could easily lead to dislocationthe radial head and become a full blown Monteggia fracture.
Discussion of management Conservative treatment with plaster cast immobliisation would therefore not be appropriate (As there was a real danger of the radial head dislocationg if the ulna shortened or angulated) and ORIF with a plate and screws was opted for. Monteggia factures are unstable and require open reduction and internal fixation. The ulna was plated, restoring its length. An x ray was taken on the operating table to check that the radial head was reduced.


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