Monteggia Fracture
A monteggia fracture will almost always require surgical treatment. If medical practitioners fail to refer a patient for an operation – either due to a failure to diagnose or due to an oversight – there may be grounds for a medical compensation claim.
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To find out if you can claim for an untreated arm fracture, please get in touch with us at Glynns Solicitors. We are dedicated clinical negligence solicitors, meaning we have the skill and expertise needed to advise you further.
We will listen to the details of your care before suggesting what steps you can take next. If we believe you have been the victim of medical negligence, we will help you get the justice you deserve.
What is a monteggia fracture?
A monteggia fracture is a type of forearm fracture. To understand the exact nature of the injury, it is necessary to understand the anatomy of the arm.
The forearm has two bones in it: the ulna and the radius. The two bones come together at each end of the forearm. At the elbow end, the ulna articulates with the radial head in the elbow.
A monteggia fractures see the ulna break in the upper third section of the bone, the impact of which causes the radial head in the elbow to dislocate.
There are four different types of monteggia fracture. Around 60% of patients will have a Type 1 monteggia fracture, which is a fracture of the ulna with radial head dislocation.
How does a monteggia fracture happen?
Monteggia fractures normally happen when someone tries to break their fall with an outstretched arm. It can also be caused by a direct blow, although normally this results in an isolated ulna fracture, rather than a monteggia fracture.
Symptoms of a monteggia fracture
A monteggia fracture will carry the same symptoms as other fractures: an intense pain at the site of the fracture – in this instance in the forearm. The tissue will also be swollen. There will be limited mobility and may also be some nerve damage.
Diagnosing a monteggia fracture
If a patient presents to A&E with these symptoms, he/she should be suspected of having a forearm fracture – especially if there is a recent history of a fall or other traumatic incident (such as a sports injury).
In order to diagnose a monteggia fracture, the entire length of the patient's forearm must be x-rayed. This should clearly show the ulna fracture. It may be difficult to detect the injury to the radial head so various x-rays may be needed to obtain a complete view.
Treating a monteggia fracture
If a child sustains a monteggia fracture, it is possible to treat the fracture without surgery. The limb should be reset and put in plaster to immobilise the joint. This is known as closed reduction.
However, a closed reduction will not be possible in adult patients. This is because there is a good chance there will be a malunion, where the bone does not reunite properly. This will adversely affect the function of the arm.
To avoid malunion of the bone, a patient must be referred for a surgical repair as quickly as possible. The arm should be put in a splint to immobilise the joint. An open reduction and internal fixation will normally be required, although the precise surgery will depend upon the nature of the injury.
Failure to diagnose a monteggia fracture
There are occasions when a monteggia fracture remains undiagnosed. This might happen because the medical practitioner who attends the patient decides there is no fracture and so does not order an x-ray.
Alternatively it may be that an x-ray is performed but the entire fracture, or part of the fracture, is missed. Often the ulna fracture is identified but the dislocated radial head is missed.
Failure to treat a monteggia fracture
There are also times when a monteggia fracture is diagnosed accurately, but medical practitioners decide that an open reduction is not necessary. Consequently a closed reduction is attempted.
However, this may not be successful as most monteggia fractures will need a surgical repair. A reasonably competent practitioner would know this and would not defer surgery, as this would risk the malunion of the bone.
Have I been the victim of medical negligence?
If your monteggia fracture was not correctly diagnosed, or was wrongly left untreated, have you been the victim of medical negligence?
Every medical practitioner has a duty of care towards his/her patients, meaning a reasonable standard of care must be provided at all times. A 'reasonable' standard of care is judged against what a reasonable body of medical men would do.
A reasonable A&E doctor would send a patient with chronic arm pain for an x-ray, suspecting a possible fracture. A reasonable radiologist would be able to diagnose a monteggia fracture. Finally, a reasonable orthopaedic surgeon would appreciate that a monteggia fracture needs open reduction surgery.
If any of these medical practitioners fails to achieve a reasonable standard of care, there will have been a breach of duty. Any patient wrongfully injured as a result of a breach of duty will be the victim of medical negligence.
Professional legal advice
To find out for certain if you have been the victim of medical negligence, you need to talk to a lawyer about the care you received.
A solicitor who deals with clinical negligence claims will be able to advise you upon your options. Finding someone who is an expert in clinical negligence is important as this will guarantee you get the best legal advice.
It is also worth noting that clinical negligence claims must be issued within three years of the event. If three years have passed since your fracture was missed or untreated, you might not be able to claim, even if you would otherwise have been entitled to compensation. Therefore it is essential not to delay in seeking professional legal advice.
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