Bado Classification

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Monteggia-fracture

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2].

Overview[1][2]

In 1803, Giovanni Battista Monteggia, an Italian surgeon, describe the Monteggia fracture as: a fracture of the proximal third of the ulna with the dislocation of the head of radius.

In 1967, Jose Luis Bado, used the "Monteggia lesion" terminology and classified this injury into the four types.

In 1991, Jupiter JB and colleagues from Boston expanded the Bado’s type II description of posterior Monteggia fracture-dislocation.


Bado Classification

Monteggia Fracture-Dislocations

Bado Classification for the Monteggia Fracture-Dislocations Mechanism of Injury
Type I

60% of cases

Fracture of the proximal or middle third of the ulna with anterior dislocation of the radial head (most common in children and young adults) (1) direct blow to posterior elbow

(2) hyper-pronated force on an outstretched arm

(3) contracted biceps resists forearm extension causing dislocation and followed by impact leading to ulna fracture

Type II

15% of cases

Fracture of the proximal or middle third of the ulna with posterior dislocation of the radial head (70 to 80% of adult Monteggia fractures) (1) Axial load directed up the forearm with a slightly flexed elbow
Type III

20% of cases

Fracture of the ulnar metaphysis (distal to coronoid process) with lateral dislocation of the radial head (1) Varus force on an extended elbow leads to a greenstick fracture of the ulna
Type IV

5% of cases

Fracture of the proximal or middle third of the ulna and radius with dislocation of the radial head in any direction (1) Rarest type and poorly understood mechanism.
Bado classification for Monteggia fractures

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References

  1. Rehim SA, Maynard MA, Sebastin SJ, Chung KC (July 2014). "Monteggia fracture dislocations: a historical review". J Hand Surg Am. 39 (7): 1384–94. doi:10.1016/j.jhsa.2014.02.024. PMC 4266382. PMID 24792923.
  2. Goyal T, Arora SS, Banerjee S, Kandwal P (May 2015). "Neglected Monteggia fracture dislocations in children: a systematic review". J Pediatr Orthop B. 24 (3): 191–9. doi:10.1097/BPB.0000000000000147. PMID 25714935.