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Age: 29

Sex: Male

Indication: Trauma

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Case #4


Findings

  • Open acute oblique proximal ulnar diaphyseal fracture with one shaft width posterior displacement, 7 cm override and apex anterior angulation
  • Anterior dislocation and proximal migration of the radial head
  • Extensive subcutaneous emphysema about the elbow and proximal forearm with multiple polygonal radiodensities


Diagnosis

  • Open Monteggia fracture/dislocation

Sample Report

Open acute oblique proximal ulnar diaphyseal fracture with one shaft width posterior displacement, 7 cm override and apex anterior angulation.

Anterior dislocation and proximal migration of the radial head.

Extensive soft tissue injury about the elbow and proximal forearm with subcutaneous emphysema and multiple polygonal radiodensities concerning for foreign bodies.


Discussion

  • It is important to raise concern for open fracture when you see soft tissue gas. While this case was certainly a clinically-obvious open fracture, more subtle cases may be missed by the clinical team
  • Think about the radius and ulna as a ring structure so that if you see one radial/ulnar fracture, look for another fracture or dislocation
  • Even in complex cases, make sure to comment on foreign bodies


Images

Monteggia fracture/dislocation with anterior dislocation of the radial head (red star) relative to the capitellum (blue star). Post-ORIF radiograph in this patient.

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