José Luis Bado reviewed Monteggia’s original fracture-dislocation description and further classified the injury into 4 types. The Bado classification defines a group of traumatic ‘double bone‘ injuries having in common a ‘Monteggia lesion‘ (ulna fracture) with a dislocation of the radio-humero-ulna joint (radial head dislocation either anterior, lateral or posterior)
- Type I: 60% of cases: Anterior radial head dislocation. Fracture ulna diaphysis with anterior angulation.
- Type II: 15% of cases. Posterior/posterolateral radial head dislocation. Fracture ulna diaphysis with posterior angulation.
- Type III: 20% of cases. Lateral/anterolateral radial head dislocation. Fracture ulna metaphysis.
- Type IV: 5% of cases. Anterior radial head dislocation. Fracture proximal third ulna AND radius.
History of the Bado Classification
1814 – Giovanni Battista Monteggia (1762–1815) recorded two observations of a traumatic lesion distinguished by a fracture of the proximal third of the ulna and an anterior dislocation of the proximal epiphysis of the radius in ‘Lussazioni delle ossa delle estremita superiori.’
…La percossa di un bastone ruppe il cubito al terzo superiore e slogò il raggio al lato opposto. In questo caso fu il cubito stesso che cedendo al colpo portò fuor di luogo il raggio adjacente.
Monteggia, Lussazioni delle ossa delle estremita superiori. 1814; V(213): 109.
…The strike of a stick broke the ulna in the upper third and dislocated the radius on the opposite side. In this case it was the ulna itself which, giving way to the blow, carried the adjoining radius out of place.
1854 – Joseph François Malgaigne (1806-1865) published on the complications of upper and lower limb fractures with associated dislocations. He proposed alternate methods for dislocation reduction in the absence of a ‘lever’ (the broken bone) to assist in the dislocation reduction. He stated ‘In any fracture of the ulna, beware of dislocation of the radial head‘
1958 – Uruguayan orthopedist José Luis Bado elaborated on the pathology, mechanics and management of the fracture-dislocation first published in Spanish, then in English in 1962
1967 – Bado introduced the term Monteggia lesion and Monteggia equivalent injuries. He defined 4 injury patterns incorporating dislocation of the radial head associated with fractures at various levels of the ulna or with injuries at the wrist. Bado argued:
Since the dislocation of the radial head can be anterior, lateral or posterior, any dislocation found with an ulnar fracture constitutes the anatomic-clinical picture of the lesion discussed by Monteggia.
Keeping these considerations in mind, we shall be able to classify under the term ‘Monteggia lesion’ a group of traumatic lesions having in common a dislocation of the radio-humero-ulnar joint, associated with a fracture of the ulna at various levels or with lesions of the wrist. This concept is different from that described by Monteggia in 1814.Bado 1967
Type I: 60% of cases: Anterior radial head dislocation. Fracture ulna diaphysis with anterior angulation.
Type II: Fracture of middle or proximal third of the ulna shaft with posterior/posterolateral radial head dislocation (often fractured). 15% of cases. Trial of conservative management, open treatment required if ulna fracture does not reduce when radial head relocated.
Type III: Fracture of the proximal ulna metaphysis with lateral dislocation fo the radial head. 20% of cases. Occurs exclusively in children. Clinical deformity with increased transverse diameter of the elbow joint. Usually conservative treatment, risk of transient radial nerve paralysis post manipulation.
Type IV: Fracture of the middle or proximal third ulna AND anterior radial head dislocation AND a fracture of the middle third of the radial shaft. Infrequent, making up 5% of lesions and exclusive to adults. Open reduction fixation.
- Giovanni Battista Monteggia (1762 – 1815)
- Joseph François Malgaigne (1806-1865)
- José Luis Bado (1903 – 1977)
- Monteggia GB. Lussazioni delle ossa delle estremita superiori. In: Monteggia GB. Instituzioni Chirurgiche. 1814; V: 109, 131-133
- Malgaigne JF. Remarques et observâtion sur les luxations compliquées de fractures, Revue médico-chirurgicale de Paris. 1853; 13: 80-92
- Malgaigne M. Mémoires sur les luxations de la partie supérieure du radius compliquées de fractures du cubitus. Revue médico-chirurgicale de Paris. 1854; 15: 215-220
- Bado JL. La lesion de Monteggia. Inter-Medica Sarandi, 1958: 328
- Bado JL. The Monteggia Lesion. 1962
- Bado JL. The Monteggia lesion. Clin Orthop Relat Res. 1967; 50: 71-86.
- Rehim SA, Maynard MA, Sebastin SJ, Chung KC. Monteggia fracture-dislocations: A Historical Review. J Hand Surg Am. 2014; 39(7): 1384–1394
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Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM Sir Charles Gairdner Hospital. Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |