Type IV Monteggia fracture in a cat

Summary

A one-year-old neutered male cat was referred for a grade IIIA open radius and ulna fracture. The mid-diaphyseal radial and ulnar fractures were associated with lateral radio-humeral and radio-ulnar dislocations. From these abnormalities, a diagnosis of type IV Monteggia fracture was made. The annular ligament was found to be intact on examination and the radial head was correctly positioned and stable after fracture reduction and plate fixation. Eighteen months postoperatively, the cat did not exhibit any signs of lameness or any signs of pain on palpation and mobilisation. Signs of mild osteoarthritis were present on radiographs.

Type IV Monteggia fractures are very rare in animals. The combination of a radial head dislocation with an intact annular ligament is uncommon. This pattern allowed a single reconstruction with two plates without a radio-ulnar screw.

Keywords

Radius ulna - fracture - cat - Monteggia

• References

• 1 Schwarz PD, Schrader SC. Ulnar fracture and dislocation of the proximal radial epiphysis (Monteggia lesion) in the dog and cat: a review of 28 cases. J Am Vet Med Assoc 1984; 185: 190-194.
• 2 Blieux V. Des fractures de Monteggia chez le chien et le chat: études anatomique, clinique et retrospective de 59 cas de fractures de l'ulna avec luxation de la tête radiale. [Monteggia fractures in the dog and cat: anatomical, clinical and retrospective studies of 59 cases of ulnar fracture with radial head dislocation]. [doctoral thesis]. Ecole Nationale Vétérinaire de Lyon, France. 2005
• 3 Bado JL. The Monteggia lesion. Clin Orthop Relat Res 1967; 50: 71-86.
• 4 Piermattei DL, Flo GL. Fractures of the Radius and Ulna. In: Brinker, Piermattei and Flo's Handbook of Small Animals Orthopedics and Fracture Repair. 4^rd ed. Philadelphia: W.B: Saunders 2006: 365-368.
• 5 Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. J Bone and Joint Surg 1976; 58 A 453-458.
• 6 Gustilo RB, Merkow RL, Templeman D. Current concepts review: The management of open fractures. J Bone and Joint Surg 1990; 72 A 299-304.
• 7 Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984; 24: 742-746.
• 8 Ormrod AN. Limb fractures in the dog and cat. IV. Fractures of the fore limb. J Small Anim Pract 1966; 7: 155-162.
• 9 Campbell JR. Nonfracture injuries to the canine elbow. J Am Vet Med Assoc 1969; 155: 735-744.
• 10 Prassinos NN. Fractures combination of the proximal antebrachium in an immature dog that resembles Monteggia fracture. Vet Comp Orthop Traumatol 2006; 19: 184-186.
• 11 Singh A, Moens NM, Nykamp S. et al What is your diagnosis? Type 1 Monteggia fracture. J Am Vet Med Assoc 2007; 231: 1345-1346.
• 12 Bush M, Owen M. Type-IV variant Monteggia fracture with concurrent proximal radial physeal fracture in a domestic shorthaired cat. Vet Comp Orthop Traumatol 2009; 22: 225-228.
• 13 Muir P, Johnson KA. Fractures of the proximal ulna in dogs. Vet Comp Orthop Traumatol 1996; 9: 88-94.
• 14 Evans HE, Christensen GC. Joints and ligaments. In: Miller's anatomy of the dog. 2^nd ed. Philadelphia: WB Saunders; 1979: 225-268.
• 15 Farrell M, Thomson DG, Carmichael S. Surgical management of traumatic elbow luxation in two cats using circumferential suture protheses. Vet Comp Orthop Traumatol 2009; 22: 66-69.
• 16 Voss K, Langley-Hobbs SJ, Montavon PM. Elbow joint. In: Feline Orthopedic Surgery and Musculoskeletal Disease. 1^st ed. Philadelphia: W.B Saunders; 2009: 359-370.
• 17 Autefage A. Fracture of the ulna. In: Johnson AL, Houlton JEF, Vannini R, editors. AO principles of fracture management in the dog and cat. New York: Thieme; 2005: 260-272.
• 18 Boudrieau RJ. Fractures of the radius and ulna. In: Slatter D, editor. Textbook of Small Animal Surgery. 3^rd ed.. Philadelphia: W.B Saunders; 2003: 1955-1973.
• 19 Voss K, Kull M, Haessig M. et al Repair of long-bone fractures in cats and small dogs with the Uni-lock mandible locking plate system. Vet Comp Orthop Traumatol 2009; 22: 398-405.
• 20 Yang EC, Eisler J. Treatment of isolated type I open fractures. Clin Orthop Relat Res 2003; 410: 289-294.
• 21 Moed BR, Kellam JF, Foster RJ. et al Immediate internal fixation of open fractures of the diaphysis of the forearm. J Bone and Joint Surg 1986; 68 A 1008-1017.
• 22 Wallace AM, De La Puerta B, Trayhorn D. et al Feline combined diaphyseal radial and ulnar fractures. Vet Comp Orthop Traumatol 2009; 22: 38-46.
• 23 Witsberger TH, Hulse DA, Kerwin SC. et al Minimally invasive application of a radial plate following placement of an ulnar rod in treating antebrachial fractures. Vet Comp Orthop Traumatol 2010; 23: 459-467.