Pediatric emergency medicine trisk 3479 3479
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Diagnosis of Monteggia fractures require a true lateral view of the elbow, with
attention to the radiocapitellar line. If a line drawn through the long axis of the
radius fails to pass through the center of the capitellum on all projections a radial
head dislocation should be considered ( Fig. 111.16 ). It is worth noting that even
bowing fractures of the ulna have been associated with radial head dislocation.
Recognition of these injuries with immediate orthopedic consultation is crucial to
prevent long-term disability. In pediatric patients, timely closed reduction of the
fracture and dislocation followed by long arm splinting will minimize risk of
permanent disability secondary to chronic irreducible radial head dislocation,
limited supination and pronation, as well as nerve injury. Galeazzi fractures often
require operative intervention, and the complications are few with proper
management.
FIGURE 111.28 Upper extremity motor nerve physical examination. A: Rock position
demonstrates median nerve motor function. B: Paper position demonstrates radial nerve motor
function. C: Scissor position demonstrates ulnar nerve motor function. D: “OK” sign
demonstrates function of the anterior interosseous nerve. (Reprinted with permission from
Waters PM, Skaggs DL, Flynn JM. Rockwood and Wilkins’ Fractures in Children . 9th ed.
Philadelphia, PA: Wolters Kluwer; 2020.)
