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Surgery for monteggia fracture11/27/2023 This article will cover commonly used fixation techniques for Monteggia fractures with a comprehensive literature review, including technical tips, outcomes, and complications.Ĭoronoid fracture Monteggia elbow fracture-dislocation elbow instability radial head fracture.Ĭopyright © 2021 American Society for Surgery of the Hand. pediatric patients who had undergone a procedure involving the. Multiple operative techniques have been described to address the broad spectrum of injuries seen in Monteggia fractures. Chronic monteggia fracture-dislocation in children - surgical strategy and results. When the opposite occurs (that is, the radius. Access to the critical coronoid fragment can be problematic from the posterior approach and may result in tenuous reduction and fixation, directly affecting the functional outcome. When the ulna is fractured and shortened, the proximal radio-ulnar joint dislocates (the Monteggia fracture). The Jupiter classification captures this injury pattern as a subgroup of Bado posterior Monteggia lesions. Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. The presence of radial head/neck fracture and comminution of the proximal ulna with coronoid involvement elevates the complexity of surgical reconstruction considerably. A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. Neglected Monteggia fracture dislocation is one of the challenging case and it becomes more of a therapeutic dilemma especially in adults. Meaningful improvements in elbow motion and radiocapitellar stability can be safely achieved in the majority of children following surgical reconstruction of missed Monteggia lesions.Monteggia fractures classically involve a proximal ulna fracture with an associated radial head dislocation. Patients who received repair of the native annular ligament were more likely to achieve lasting radiocapitellar joint stability (P=0.03) when compared with patients who received annular ligament reconstruction or if the annular ligament was not addressed. Therefore, a two-stage strategy, including. One-stage operation of ulnar corrective osteotomy and open reduction of RHD might result in many complications. Six of the 9 patients who experienced redislocation underwent early revision and achieved uncomplicated longer term results. A neglected Monteggia fracture is defined as the fracture of the proximal ulna associated with radial head dislocation (RHD) without undergoing any treatment for 4 weeks or more after injury. Nine patients (17%) had redislocation of the radiocapitellar joint, and 4 patients (8%) had radiographic resubluxation. Congruent radiocapitellar alignment was maintained in 39 patients (75%). Forearm range of motion also improved from a median of 80 degrees of pronation and 58 degrees of supination preoperatively to 80 degrees of pronation (P=0.54) and 80 degrees of supination (P<0.001) postoperatively. The median elbow range of motion improved from 108 degrees of flexion and 5 degrees short of full extension preoperatively to 140 degrees of flexion (P<0.001) and full extension (P=0.10) postoperatively. After the surgery they will usually put a cast on to provide stability while the fracture heals. Median clinical and radiographic follow-up was 19.1 months. This surgery will be done by a surgical specialist who is trained to repair injuries and fractures to the bone. Electronic medical records, including clinic notes, radiographic images, and operative reports, were reviewed for study analysis. The median patient age at the time of surgery was 6.8 years, and the median time from injury to surgery was 12.9 weeks. The purpose of this investigation was to assess the clinical and radiographic results of a modified surgical technique for missed Monteggia fracture-dislocations.Ī retrospective evaluation of 52 patients who underwent surgical reconstruction of missed Monteggia fracture-dislocations at a tertiary pediatric hospital was performed. Numerous surgical techniques have been advocated to reconstruct long-standing Monteggia injures in efforts to maximize long-term upper limb function. The condition is named after Giovanni Battista Monteggia, who. Chronic Monteggia lesions in children may cause pain, deformity, decreased range of motion, and neurological symptoms. Monteggia fractures may be managed conservatively in children with closed reduction (resetting and casting), but due to high risk of displacement causing. Monteggia fracture is a rare fracture that is observed in only 0.4 of all forearm fractures 2.
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