International Emergency Nursing (2010) 18, 169–170

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Sara Lawrence BSc (Hons) SRR, PGD (Advanced Practitioner) *,Jane Sacks DCR (R) SRR, DRI, FAETC, PGCert (Advanced Practitioner)

Department of Radiology, Stepping Hill Hospital, Stockport, UK

This 5 year old male attended the Emergency Department following a fall onto his forearm. He presented with a swollentender mid radius.

What is your diagnosis?

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* Corresponding author. Tel.: +44 161 419 4163, +44 161 419 3204.E-mail address: sara.lawrence@stockport.nhs.uk (S. Lawrence).

170 S. Lawrence, J. Sacks

The x-rays show a slightly angulated fracture to the midshaft of the ulna and anterior dislocation of the radial head. Thisis a Monteggia fracture dislocation (note the radio-capitellar line on the lateral projection does not bisect the capitellum).The forearm is composed of the radius and ulna, joined by proximal and distal radio-ulnar joints and intraosseous ligament.

When an isolated fracture of the radius or ulna is demonstrated, the wrist and elbow joints should always be x-rayedbecause isolated fractures of a long bone are uncommon. This is because whenever one of the two bones of the forearmfractures with shortening or angulation, then something usually happens to ‘‘shorten’’ the other bone, for example, theother bone can also fracture; the other bone can dislocate; ligaments are torn.