M.E.Müller: Atlas: Fracture 22-B1

Radius/Ulna, Diaphysis,
wedge fracture,
ulna, radius intact 0,36% of the total
2,81% of the radius/ulna
11,53% of the segment

90 fractures
45,7% group
76%M, 24%F

60 fractures
30,5% group
72%M, 28%F

47 fractures
23,8% group
83%M, 17%F

Intact wedge Fragmented wedge With dislocation radial head (Monteggia)

These are fractures of the diaphysis of the ulna with a third wedge fragment. The association of a radial head dislocation composes the typical Monteggia lesion. Ref. Manual of Internal Fixation:
232 - 251. 466 - 475.
Surgeon. RO, MS, MS.

All of the considerations made for the type A fractures are valid for the type B but with the added difficulty of a third fragment that, in spite of being usually small, at this level it constitutes a relatively important cortical bone loss because of the limited circumferential surface and thick cortices with minimal medullary cavity of the bones of the forearm. Quite frequently the third fragment is avascular, therefore with little biological influence. Its reduction must be precise in order to obtain the maximal advantage of its mechanical value and expedite its revascularization by creeping substitution. The addition of

even a small amount of autologous cancellous bone graft, easy to obtain from the olecranon, will always be advantageous.

In the Monteggia lesions, the reduction of the radial head is usually easy and reconstitutes the lenght of the forearm making easier the reduction of the ulna, that can then be internally fixed by the technique described. The reconstruction of the annular ligament of the radius is rarely necessary.

preoperative postoperative + 4 months

preoperative + 4 months

preoperative + 4 months




						Radius/Ulna, Diaphysis, wedge fracture, ulna, radius intact	0,36% of the total 2,81% of the radius/ulna 11,53% of the segment






These are fractures of the diaphysis of the ulna with a third wedge fragment. The association of a radial head dislocation composes the typical Monteggia lesion.		Ref. Manual of Internal Fixation: 232 - 251. 466 - 475. Surgeon. RO, MS, MS.

All of the considerations made for the type A fractures are valid for the type B but with the added difficulty of a third fragment that, in spite of being usually small, at this level it constitutes a relatively important cortical bone loss because of the limited circumferential surface and thick cortices with minimal medullary cavity of the bones of the forearm. Quite frequently the third fragment is avascular, therefore with little biological influence. Its reduction must be precise in order to obtain the maximal advantage of its mechanical value and expedite its revascularization by creeping substitution. The addition of	even a small amount of autologous cancellous bone graft, easy to obtain from the olecranon, will always be advantageous. In the Monteggia lesions, the reduction of the radial head is usually easy and reconstitutes the lenght of the forearm making easier the reduction of the ulna, that can then be internally fixed by the technique described. The reconstruction of the annular ligament of the radius is rarely necessary.