Μετεγχειρητική Φυσικοθεραπευτική Παρέμβαση σε Κατάγματα – Εξαρθρήματα Galeazzi και Monteggia

Abstract

The treatment of choice for Galeazzi and Monteggia fractures - dislocations is the surgical stabilization. Galeazzi fractures are best treated with open reduction of the radius and the distal radioulnar joint, while open reduction and internal fixation of the ulnar fracture and reduction of the displaced radial head is carried out for Monteggia. Surgical approaches and reduction techniques must be fully established by the orthopedic surgeon in order to stabilize the fracture and repair the dislocation equally in both cases. During the surgery muscles, tendons, ligaments and the articular capsule of the injured area are strained, while some surgical approaches carry a technically high risk due to the presence of nervous and vascular tissue in these areas. This high complexity requires a well-organized and up-to-date physiotherapeutic intervention. Postoperative physiotherapy should aim to ensure the surgical outcome in conjunction with the patient's rehabilitation, as well as protecting the injured area from excessive loads during the kinesiotherapy and strengthening program. The literature review was performed on the PubMed, Cochrane Library, Scopus, Google Scholar, Medscape and ResearchGate databases as well as on the AO Foundation website, with relevant keywords and phrases [Galeazzi fracture-dislocation, Monteggia fracture-dislocation, Galeazzi fractures Classification System, Monteggia fractures Classification System, Fracture of the radius with dislocation of distal radioulnar joint, Ulnar fracture with radius dislocation, ORIF - Compression Planting, Anterior-volar approach (Henry), Speed and Boyd's approach, Galeazzi fracture dislocation postoperative rehabilitation, Galeazzi fracture therapy protocol, Distal radius fracture orif rehabilitation protocol, Clinical protocol Galeazzi frx, Radial fracture with druj dislocation clinical guidelines, Monteggia fracture rehabilitation, Monteggia fracture treatment, Monteggia fracture physical therapy, Monteggia fracture rehabilitation protocols, Evaluation and management of Monteggia fractures Postoperative management of Monteggia fractures]. During this review, no comprehensive guidelines were found to have been published specifically for the postoperative physiotherapy intervention of Galeazzi and Monteggia fractures. However, some clinical guidelines have been found regarding postoperative intervention protocols for fractures of the distal third of the radius, dislocation of the distal radioulnar joint, fractures of the proximal third of the ulna and dislocation of the radial head. The integrated physiotherapy intervention of the Galeazzi and Monteggia fractures - dislocations requires the combination of these individual clinical instructions. Specifically, the physiotherapy intervention for Galeazzi fractures-dislocations requires the combination of both the distal radius fracture΄s rehabilitation and the distal radioulnar joint’s dislocation rehabilitation. The Monteggia fracturesdislocations is required the proximal ulna fracture’s rehabilitation combined with the radial head dislocation’s rehabilitation. In the present thesis, the physiotherapy intervention’s considerations of Galeazzi or Monteggia fracture - dislocation are presented, regarding the fracture - dislocation type, the surgical treatment or the conservative management, as well as the corresponding postoperative precautions for each case and the loads exerted on the location of the injury. These considerations could be used by professional physiotherapists in order to organize the rehabilitation program, to minimize the risk of postoperative complications and to achieve the best possible functional outcome for patients with a Galeazzi or Monteggia fracture - dislocation. KEY WORDS: Galeazzi fracture – dislocation, Monteggia fracture – dislocation, Open Reduction Internal Fixation surgery-ORIF, Postoperative physiotherapeutic intervention