Paediatric Forearm Fracture & Dislocations

Montegia Classification

**Baldo Classification of Montegia Fracture Dislocations**
Type	Description
I	Ulnar has apex anterior & the radial head is anterior (75%) – supinate arm
II	Posterior ulnar apex & posterior radial head- pronate arm
III	Lateral ulnar angulation & dislocation of the radial head – arm in neutral
IV	Anterior dislocation of the head & fracture of the shaft of the radius

**Treatment of Montegia Fractures**
Type	Treatment
Type 1	>90° of elbow flexion & supination
Type 2	elbow extension & pronation
Type 3	20 degree elbow flexion & neutral rotation
Type 4	generally open reduction of forearm

Closed reduction & anatomic reduction of the ulna is required otherwise the radial head will not stay reduced

Progressive valgus deformity
Unstable elbow in valgus
Good results by reconstructing up to 4 years after the injury
Arthrogram will show if it is congentital versus post-traumatic – based on hole in capsule if traumatic
Make sure that this is not a congenital dislocation
Evaluate the joint surface intraoperatively
Open reduction of the radial head & release of the interposed annular ligament, ulnar osteotomy to address the bowing & ↑ length
Internal fixation of the ulnar osteotomy
Repair of the the annular ligament – Bell Toss if unstable – use a long slip of the triceps fascia & it is used to fashion a loop around the radial neck to hold the reduction
If still unstable pin the radius to the capitellum

< 12 – closed reduciton of the radious & immobilization in supination
if in doubt order a CT scan
> 12 ORIF of the radius & possible closed reduction of the ulna, if stable immobilize in cast with supination, if unstable or not reducible open the drug dorsally & clean out the crap & then pin it with repair of the local TFCC