SURGICAL OUTCOME OF PERCUTANEOUS PIN FIXATION OF PROXIMAL THIRD FRACTURE OF ULNA IN MONTEGGIA FRACTURE DISLOCATION IN CHILDREN

Abstract

Introduction: Monteggia fracture dislocation is a rare and severe injury of both paediatric and adult forearm and elbow.It was described for the rst time by GIOVANNI BATTISTA MONTEGGIA in 1840,who reported two cases of fracture of the proximal third of ulna with conjoint ventral dislocation of the proximal radius. In 1967 JOSE LUIS BADO published a classication scheme of monteggia lesion based on the direction of the dislocation of radial head,this anatomical classication was suitable for both adults and children .Monteggia fracture dislocations constitute about 1% – 2% of all forearm fractures . Monteggia fractures remain challenging paediatric injuries because of difculties in diagnosis , propensity for instability and complexity of late reconstruction. More than 50% of these fracture dislocation are misdiagnosed in children and leads to dysfunction of elbow joint. The xation and stabilization of ulna fracture will automatically reduce the radial head dislocation. The aim of this study is to evaluate a group of paediatric patients with Monteggia lesion and its equivalents treated by percutaneous xation of proximal third ulna fracture with k wire after reduction of fracture ulna and dislocated radio capitular joint under c-arm guidance. Materials and methods We treated 18 children of age ranging between 6 to 12 years with Monteggia fracture dislocation of the forearm with percutaneous xation of the proximal third fracture of ulna with k wires after reduction of fracture and dislocated radio-capitular joint under C-arm control.The elbow is immobilized in exion with plaster of paris slab and bandage for a period of four weeks and mobilization of elbow is started after four weeks. By the end of 8 weeks K-wire removed. All fractures are xed with in twenty four hours. The results Results : are good, there is no incidents of any stiffness. Range of movements of elbow and forearm are well preserved.The function of elbow and forearm are satisfactory.Conclusion:A good outcome after Monteggia injury in a child requires early diagnosis and prompt stable anatomical reduction of the ulna fracture and this can be achieved through stabilization of ulna by percutaneous intramedullary k wires