Monteggia Fracture Dislocation Research Articles

Evaluation of optimizing Monteggia fracture-dislocation care: surgical innovations, radiological insights, and functional rehabilitation in adult patients

Background: Monteggia fractures, rare in adults, involve proximal ulna fracture and radial head dislocation. Managing these injuries poses challenges, fueling historical debates and driving advancements in internal fixation. Watson Jones' frustration highlights the ongoing pursuit of effective surgical approaches for optimal outcomes and functional limb restoration. his study aims to evaluate Monteggia fracture-dislocation treatment by analyzing radiological outcomes for structural insights and alignment post-surgery. Methods: This prospective observational study, conducted at Swapno general hospital, Mirpur-2, Dhaka, Bangladesh from 1st January 2021 to 31 January 2024, enrolled 30 patients with radiologically confirmed Monteggia fracture-dislocation. Surgical procedures involved creating an interval, anatomical reduction, and fixation, with regular follow-ups assessing outcomes, including range of motion, X-rays, and VAS scores, while statistical analysis utilized SPSS version 23. Results: The highest frequency percentage in the age distribution was observed among individuals aged 41-45, constituting 20% of the total sample, while the lowest frequencies were recorded in the 31-35 and >51 age groups, each representing 10% of the sample. Physical assault emerged as the leading cause of injury, accounting for 40% of cases, followed by road traffic accidents at 36.66% and falls at 23.33%. In terms of final outcomes, the majority of patients (43.33%) achieved a good outcome, while the lowest percentage (10%) resulted in poor outcomes. Conclusions: In conclusion, addressing Monteggia fracture-dislocation in adults requires navigating inherent complexities. Modern internal fixation methods prove impactful, emphasizing the need for precise classification and stable anatomical reduction.

Utility of fast MRIs in pediatric elbow injuries

BackgroundPediatric elbow trauma presents a diagnostic challenge for clinicians. Radiographs may be insufficient in assessing the radiocapitellar alignment and advanced imaging or invasive procedures such as an intraoperative arthrogram may be indicated. The purpose of this study is to describe the application and utility of fast magnetic resonance imaging (MRI) in the diagnosis and management of traumatic elbow injuries in pediatric patients. MethodsWe reviewed pediatric patients who underwent a fast MRI of the elbow between 2014-2022. A fast MRI was defined as an MRI using rapid sequences, accelerated conventional sequences, or fewer conventional sequences than a standard exam. Imaging for chronic or non-traumatic injuries was excluded. We identified patient demographics, MRI scan times, and clinical course. ResultsTwenty-three patients (8 females and 15 males) with fast elbow MRI scans were identified. The mean age was 5 years (range 2-12 years, SD 2 years). All patients had radiographs and four had CT scans prior to MRI. The average scanning time was 14 minutes (SD 6 minutes). Only one patient required anesthesia. Twenty of the 23 patients had a fracture identified on elbow radiographs and 8 were Monteggia fracture-dislocations. Nine of these patients demonstrated subluxation of the radiocapitellar joint requiring operative management in 8 patients, and one additional patient underwent surgery for displaced radial neck fracture. Three patients sustained an elbow dislocation without fracture identified on radiographs; of these, one had persistent radiocapitellar subluxation on MRI requiring surgical management. A total of 13 patients (56.5%) did not require operative management based on fast MRI findings. Outcome data was available for 22 patients with mean follow up was 23.6 months. One patient had residual pain and 8 had some range of motion limitation at final follow-up. All patients had reduced elbow joint on follow-up radiographs. ConclusionsFast MRIs can assist with the clinical evaluation of acute elbow injury in pediatric patients with equivocal radiographic findings and particularly in those with possible radiocapitellar subluxation/dislocation. This novel imaging technique has the potential to change clinical management, decrease the need for unnecessary procedures, and prevent complications of missed injuries.

Step-cut, biplanar, elongation and angulation ulnar osteotomy with annular ligament reconstruction in neglected Monteggia fracture dislocation in children: a retrospective study

Monteggia fracture dislocation is an infrequent injury in children, with around 20-50% cases being missed on initial consultation; leading to their chronic and neglected forms leading to number of complications; thus justifying their operative management. Various treatment modalities have been suggested in the literature for these neglected injuries. A retrospective study of 7 patients (5 males and 2 females), with mean age of 9.58 years (7-14 years); with neglected Monteggia fracture dislocation undergoing corrective reconstructive surgery in the form of elongation and angulation proximal ulnar osteotomy with radial head reduction combined with annular ligament reconstruction was conducted and was then evaluated clinically and functionally using Mayo Elbow Performance Index (MEPI) score; and radiographicaly were graded as good, moderate or poor. The mean interval from time of injury to the time to corrective surgery was 10.58 weeks (range 6-16 weeks). The mean improvement in the post operative MEPI score was 23.57. The mean improvement in the post operative flexion-extension arc was 28.57˚, while that in the supination-pronation arc was 20.72˚. We concluded that Step-cut, biplanar, elongation and angulation proximal ulnar osteotomy with additional reinforcement in the form of annular ligament reconstruction is an effective technique to treat neglected Monteggia fracture dislocations in children; having excellent clinical, functional and radiological outcomes.

Proximal radioulnar synostosis following Monteggia fracture-dislocation: a case report

Introduction and importance: Radioulnar synostosis is a rare complication of a forearm fracture that restricts pronation-supination. This study presents a case of proximal radioulnar synostosis in an adult male after Monteggia fracture-dislocation who had a loss of pronation and supination movements. Case presentation: Herein, we report a case of proximal radioulnar synostosis in a 43-year-old man who presented with loss of pronation and supination of the right forearm that restricted his daily activities. He had a history of Monteggia fracture-dislocation 9 months back, which was managed with open reduction and internal fixation with a dynamic compression plate. Plain radiography and computed tomography of the right forearm after 9 months of operation showed an implant in situ with proximal radioulnar synostosis. Implant removal was performed and the excess fibro-osseous connection in the proximal radius and ulna was removed. Clinical discussion: Forearm injuries that affect the interosseous membrane may result in radioulnar synostosis. Trauma and treatment-related factors increase the risk of radioulnar synostosis. The fibro-osseous fusion between the forearm bones restricts the pronation and supination movements. Conclusion: Loss of pronation-supination following forearm fracture should raise suspicion of radioulnar synostosis.

The Boyd approach: a valuable alternative to treating simple to complex elbow fractures and dislocations.

The Boyd approach is a single-incision posterior approach to the proximal radius and ulna based on a lateral anconeus muscle reflection and release of the lateral collateral ligamentous complex. This approach remains a lesser-used technique following early reports of proximal radioulnar synostosis and postoperative elbow instability. Although limited by small case series, recent literature does not support these early reported complications. This study presents a single surgeon's outcomes using the Boyd approach for the treatment of simple to complex elbow injuries. Following institutional review board approval, a retrospective review of all patients with simple to complex elbow injuries treated consecutively using a Boyd approach by a shoulder and elbow surgeon was conducted from 2016 to 2020. All patients with at least 1 postoperative clinic visit were included. Data collected included patient demographics, injury description, postoperative complications, elbow range of motion, and radiographic findings including heterotopic ossification and proximal radioulnar synostosis. Categorical and continuous variables were reported using descriptive statistics. A total of 44 patients were included with an average age of 49 years (range 13-82 years). The most commonly treated injuries were Monteggia fracture-dislocations (32%) and terrible triad injuries (18%). Average follow-up was 8 months (range 1-24 months). Final average elbow active arc of motion was from 20° (range 0°-70°) of extension to 124° (range 75°-150°) of flexion. Final supination and pronation were 53° (range 0°-80°) and 66° (range 0°-90°), respectively. There were no cases of proximal radioulnar synostosis. Heterotopic ossification contributing to less than functional elbow range of motion occurred in 2 (5%) patients who elected conservative management. There was 1 (2%) case of early postoperative posterolateral instability due to repair failure of injured ligaments that required revision using a ligament augmentation procedure. Five (11%) patients experienced postoperative neuropathy, including 4 (9%) with ulnar neuropathy. Of these, 1 underwent ulnar nerve transposition, 2 were improving, and 1 had persistent symptoms at final follow-up. This is the largest case series available demonstrating the safe utilization of the Boyd approach for the treatment of simple to complex elbow injuries. Postoperative complications including synostosis and elbow instability may not be as common as previously understood.

A STUDY ON SURGICAL MANAGEMENT OF MONTEGGIA FRACTURE-DISLOCATION IN ADULTS

Introduction: Open reduction and internal fixation of the ulna with dynamic compression plate and screws not only prevent malunion or non-union but also achieve rapid union of the fracture site. Objectives: The objective of the study was to study the functional outcome of Monteggia fracture-dislocation in adults by surgical management. Methods: Twenty cases of simple Monteggia fracture-dislocation in adults were treated by open reduction and internal fixation with a minimum six-holed AO 3.5 mm dynamic compression plate of the ulna with closed reduction of the radial head. In a case with a delayed presentation, the radial head was removed. The follow-up ranged from 5 to 15 months. Results: Right elbow affliction was more common in males than left. The majority of fracture-dislocation cases resulted from auto accidents. With an average age of 35.9 years, fracture dislocations were more prevalent in the third and fourth decades of life. According to Bado’s categorization, Type 1 fracture-dislocation accounted for the majority of the cases. To avoid radial head redislocation, the upper limb was immobilized with the elbow flexed 110–120° and the forearm supinated. We had 13 (65%) instances with great results using the Anderson et al. grading system, six (30%) with good results, one (5%) with bad results, and no cases with failure. The only problems were a superficial infection and posterior interosseous nerve damage, both of which healed on their own when the radial head dislocation was closed down and the ulna was internally fixed with an AO 3.5 mm dynamic compression plate. Conclusions: Adults with Monteggia fracture-dislocation can be treated simply and effectively with a high level of functional result utilizing the approach of early closed reduction of the radial head and open reduction and internal fixation of the ulna using a minimum of six holes AO 3.5 mm dynamic compression plate.

Monteggia Fractures: Assessment of the Results of a Series of 17 Cases

The Monteggia fracture is characterized by a combination of cubital fracture and radial head dislocation. In this retrospective study, we analyzed 17 cases of Monteggia fracture-dislocation, which were collected between 2006 and 2011 in the Traumatology-Orthopedics department of Ibn Sina Hospital. Patients ranged in age from 16 to 56 years, and radial head dislocation was anterior in 11 cases, posterior in 3 cases, and lateral in 3 cases. According to the Bado classification, the anatomopathological aspect was type I in 10 cases, type II in 3 cases, type III in 3 cases, and type IV in one case. All patients were surgically treated by osteosynthesis, with different types of cubital fracture fixation. Functional results were evaluated using DASH and Broberg-Morrey scores, which showed 36% very good results, 45% good results, 9.5% average results, and 9.5% poor results. In conclusion, it is important to diagnose and treat Monteggia fractures early, which require a quality radiograph to detect radial head dislocation. Functional results are satisfactory if appropriate treatment is applied.

Radiological and Functional Outcome of Internal Fixation of Monteggia Fracture Dislocation by DCP in Adult Patients

Background: Surgical reduction and internal fixation are the mainstays for the treatment of the Monteggia fracture-dislocation in adult and there are various surgical modalities for internal fixation. Various types of implants used in fixation of Monteggia fracture dislocation in adult and the outcome also differ. Small DCP is one of the important implants. The fracture of the proximal third of the ulna with dislocation of the head of the radius was commonly known as Monteggia fracture dislocation. Objective: To assess the radiological and functional outcome of internal fixation of monteggia fracture dislocation by (DCP) in adult patients. Methods: This prospective observational study had been conducted in Monno Medical College and Hospital, Manikganj, to evaluate the results of open reduction and internal fixation of the ulna with small DCP and anatomical reduction of radial head in early cases of Monteggia fracture dislocation in adult from January 2022 to December 2022. Total 40 patients with radiologically proven closed Monteggia fracture-dislocation that were enrolled in this study by purposive sampling method. Radiological and functional outcome were assessed and followed up for 24 weeks. Results: Results were evaluated by Quick DASH score, VAS scale, ROM of flexion-extension and supination-pronation. Final functional outcome was done with Anderson criteria. Results: Total 40 patients were included. Among 15 (37.5%) patients were from 20-29 years age group, 8 (20.0%) were from 30-39 years age group, 11 (27.5%) were from 40-49 years age group and 6 (15.0%) were from 50-55 years age group. The mean age of the patients was 35.96±11.48 years where minimum age was 20 years and maximum age was 55 years. 32 (80.0%) patients were male and 8 (20.0%) patients were female. Out of the 40 patients, 35 (87.5%) presented with Bado type I fracture and 5 (12.5%) presented with Bado type II fracture. The mean time interval between injury and surgery was 10.13±3.86 days. Post-operative complications (tourniquet palsy and wound infection) developed in 5 (12.5%) patients. According to Anderson criteria nine (22.5%) patients had excellent, 25 (62.5%) patients had good, 3 (7.5%) had fair and 7 (7.5%) patients had poor outcome. Final outcome was satisfactory (excellent and good) in 35 (87.5%) patients and unsatisfactory (fair and poor) in 5 (12.5%) patients. Patients who had Bado type II fracture had less satisfactory outcome (p=0.004). Again, patients who had more time interval between injury and surgery also had less satisfactory outcome (p=0.012). Conclusion: Monteggia fractures are uncommon injuries. The commonest type of monteggia fracture dislocation in adults according to Bado’s classification is type-1. Operative treatment of Monteggia fracture-dislocation by the selected implant, leads to excellent to good radiological and functional result with uncomplicated recovery in majority of the cases.

Adult Monteggia Fracture-Dislocations

Adult Monteggia fracture-dislocations are a rare occurrence in the adult population. The extent of the injury can vary from a simple proximal ulnar shaft fracture with a radial head dislocation to a complex comminuted fracture with associated injuries. Major factors that contribute to the complexity of the injury include coronoid fracture, radial head comminution, and ulnohumeral instability. Appropriate fixation of the ulna in anatomic alignment is crucial in achieving radial head reduction and limiting complications. While most Monteggia fracture-dislocations have favorable outcomes, it is important to recognize potential poor prognostic factors that can alter the functional outcomes of patients and increase reoperation rates. Knowledge of the relevant anatomy, evaluation, imaging, and management are imperative to improve outcomes and decrease complications for patients with these injuries.

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

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

Fracture-Dislocations of the Elbow: A Comparison of Monteggia and Terrible Triad Fracture Patterns.

Fracture-dislocations of the elbow are a spectrum of injuries that have varying outcomes and complications, such as limited range of motion and long-term pain. The Monteggia fracture-dislocation and terrible triad fracture-dislocation are 2 such injury patterns that occur secondary to different mechanisms. This study sought to compare complication profiles and patient outcomes associated with these 2 distinct injury patterns. A retrospective chart review of all adult patients treated by 1 of 3 orthopedic traumatologists at a major academic center for operative fixation for either a Monteggia fracture-dislocation or a terrible triad elbow fracture-dislocation over a 12-year period was performed. Data collected included demographics, surgical data, patient-reported pain and elbow stiffness, elbow range of motion, presence of elbow joint contracture, nerve injuries, healing complications, and need for reoperation. The review included 105 patients, 58 with Monteggia injury and 47 with terrible triad injury, who had complete follow-up and radiographic imaging available. At latest follow-up, the 2 groups had similar rates of pain, reoperation, and ultimate elbow range of motion in flexion, extension, pronation, and supination. Elbow contractures requiring operative release were more commonly associated with terrible triad injury, and the incidence of nonunion was significantly greater in Monteggia fractures. A Monteggia fracture-dislocation portends a higher risk of ulna nonunion, whereas terrible triad injury is associated with elbow contracture. Despite their unique complications, both patterns ultimately have high rates of reoperation as their unique complications are both indications for operative repair. Patients should be appropriately counseled on the complication profile of their unique injury pattern. [Orthopedics. 2023;46(3):158-163.].

Outcomes and experience after open reduction for chronic Monteggia fracture in children.

BackgroundThe treatment of chronic Monteggia fracture-dislocation (CMF) remains controversial and challenging for surgeons. We describe our initial experience with ulnar osteotomy and angulation on correction with modified open surgery and evaluate outcomes from clinical and radiographic findings.MethodsWe retrospectively reviewed 18 children with a mean age of 6.78±2.67 years old who underwent surgical treatment because of CMF. Electronic medical records of Bado type, complaints, Kim scores, and complications were recorded. Radiographic parameters of maximum interosseous distance (MID), proportional ulnar length (PUL), lengthening, and bending angle of the ulna were summarized. The final reduction statuses of the radial head were reviewed. Parameters were compared at the time of pre-operation and the last follow-up. The relationship between the lengthening and angulation of ulna and the interval was calculated.ResultsThe mean interval was 11.1 [1–48] months and the follow-up time was 46.6 [24–96] months. A good reduction was observed in 15 (83.33%) patients, while 3 (16.67%) patients were fair. Postoperatively, the Kim scores were improved, from 59.17±18.17 to 90±6.64 (P=0.000). The mean posterior bending angle was 12.88° (range, 3 to 25°), and the mean amount of elongation of the ulna was 8.78 mm (range, 3.61 to 17.52 mm). The lengthening of the ulna was proportional to the magnitude of angulation of the ulna (r=0.648, P=0.004), and a positive correlation was also seen between the lengthening and the interval (r=0.632, P=0.005) and the angulation and the interval (r=0.502, P=0.034). The PUL and MID were significantly increased from 1.06±0.03 and 1.11±0.26 to 1.13±0.11 (P=0.047) and 1.28±0.27 (P=0.021), separately.ConclusionsWe highlight ulnar osteotomy as the essential procedure during reconstruction surgeries. Stabilization of the radial head with adequate elongation and balanced angulation of the osteotomy through direct observation is the main way to ensure and maintain satisfactory outcomes. With the extension of the interval, it is more necessary to increase the lengthening and angulation in positive proportion. PUL is a useful parameter in evaluating the mismatch between ulna and radius in CMF.

Risk factors for redislocation of chronic Monteggia fracture-dislocation in children after reconstruction surgery.

Monteggia fracture-dislocation refers to traumatic ulnar fractures and dislocation of the radial head, which is one of the most frequently missed injuries, especially in children. The most widespread attitude towards chronic Monteggia lesion is the open reduction of the radial head associated with ulnar osteotomy with or without annular ligament reconstruction. Our study aimed to analyze the risk factors for redislocation after surgical management of chronic Monteggia lesion and the benefits of annular ligament reconstruction and radiocapitellar pinning in paediatric. We retrospectively reviewed patients treated with reconstruction surgery for chronic Monteggia fracture-dislocation in our department between 2005 and 2017, with a minimum two years' follow-up. The reconstruction surgery included ulnar osteotomy performed in all patients, annular ligament repair or reconstruction or fixation of radiocapitellar joint, or radial osteotomy in some patients. We collected the related clinical data and evaluated the risk factors of redislocation using logistic regression analyses and a two-piecewise linear regression model with a smoothing function, after reconstruction. Throughout a mean six years' follow-up (range, 2-14years), 62 patients (42 males, 20 females; average age 6.49years range, 2-13years) were reviewed. Of the radiocapitellar joints, 16.1% was noted to have redislocation. Univariate risk analysis showed age, time from injury to surgery, and radial osteotomy were risk factors for a recurrent radiocapitellar redislocation. Time from injury to surgery was found to be independent predictor of redislocation in multivariate analysis. However, there were significant nonlinear associations between time from injury to surgery and redislocation in multivariate logistic regression analysis after multivariate adjustment (p for nonlinear = 0.023). Every one month increase was associated with a 1.37-fold increase in redislocation, in participants within oneyear after injury. In conclusion, the surgery of chronic Monteggia fracture-dislocation should be done as quickly as possible within oneyear after injury. Associated annular ligament reconstruction or fixation of radiocapitellar joint does not seem to be helpful.

Outcomes After Operative Treatment of Pediatric Monteggia Fracture-Dislocations: Comparison Between Open and Closed Injuries.

Open pediatric Monteggia fracture-dislocations are a relatively uncommon injury pattern, with limited numbers reported in previous series. Open fracture-dislocations frequently represent more severe injury patterns with potential for contamination. We aim to determine differences in long-term clinical and functional outcomes in the operative management of closed versus open pediatric Monteggia fracture-dislocations. A retrospective review of operatively treated pediatric Monteggia fracture-dislocations was performed. Closed versus open injuries were compared in both clinical outcomes, as well as patient-reported outcomes through Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Of 30 operatively treated injuries, 12/30 (40%) were open fracture-dislocations. Patients were followed clinically for an average of 15.65 months in open injuries and an average of 4.61 months in closed injuries. A trend toward increased time to union was observed, however, significance was not achieved; open injuries averaged 8.0 versus 5.8 weeks for closed injuries ( P =0.07). Two patients (11%) in the closed fracture group experienced postoperative complications; both were minor. Five patients (42%) in the open fracture-dislocation group experienced a total of 6 postoperative complications; 5 of the 6 complications were major. QuickDASH scores were obtained at an average of 5 years postoperatively; mean QuickDASH scores were higher in the open fracture group, 13.1, compared with the closed fracture group, 5.9 ( P =0.038). Increased QuickDASH scores were independently associated with presence of postoperative complications. QuickDASH score could be expected to increase by 12.5 points in those with major complications ( P =0.044). We present the largest single cohort of pediatric open Monteggia fracture-dislocation injuries to date. These injuries are predictive of poorer outcomes including trend toward increased time to union, increased risk of major complication, and can independently predict worse long-term patient-reported functional outcomes. Level III-these data represent a retrospective comparative study of clinical and functional outcomes.

Outcome of Monteggia Fracture Dislocation in Children Treated With K Wires in Nepalgunj Medical College

Introduction: Monteggia fracture dislocations are rare injuries (<5%) where missed treatment results into deformity and dysfunction of forearm and hand. For the better functional result early diagnosis, accurate reduction of radial head and rigid fixation of ulna and immobilization during post-operative period for ligamentous healing around radius is vital. So operative treatment has been the primary method of treatment to prevent deformity and disability in monteggia fracture dislocation.
 Aims: The aim of this study was to evaluate the time taken to unite fractures, complications encountered and assess the functional outcome on the basis of K-wire fixation in monteggia fracture dislocation in children.
 Methods: A cross-sectional observational study was conducted in Nepalgunj Medical College and Teaching Hospital, Kohalpur, Banke with monteggia fracture dislocation in children.
 Results: Thirty-two monteggia fracture dislocation in children between six to 14 years of age were treated with intramedullary K-wires after reduction of radial head. Seven cases had open reduction, and five needed trans-capitellar K-wire supplementation. Mean union time was 8.44±1.94 weeks ranging from seven to 12 weeks. The functional outcome on the basis of Anderson’s scoring system was excellent in 25(78.1%), good in three and optimal in four cases.
 Conclusion: Monteggia fracture dislocation is better treated early and early mobilization of elbow joint is needed for better functional results.

Monteggia Fracture-Dislocation.

A Monteggia fracture-dislocation involves a proximal one-third of the ulna fracture with a concomitant dislocation of the radial head proximally at the elbow. This fracture and dislocation often results from a fall on the outstretched hand (FOOSH) low-energy mechanism of injury. One must have a high index of suspicion with any ulnar fractures to look for a radial head dislocation so that the dislocation component is not missed. These injuries often require early orthopedic intervention. Any delays in treatment can lead to poor long-term outcomes including chronic valgus instability and radiocapitellar osteoarthrosis.

A Novel Case of Neglected Monteggia Fracture Dislocation


 
 
 
 Background: The Monteggia fracture-dislocation is a rare condition among children, and its treatment is still controversial. The treatment can become quite complicated when the diagnosis is delayed. There is a broad range of surgical treatments with various complications like subluxations, degenerative changes, and radial head deformity. The present case was reported as a novel surgical treatment choice for neglected Monteggia fracture-dislocation.
 Case Report: A 16 year-old boy presented with left elbow severe range of motion (ROM) limitation and pain who was diagnosed with neglected Monteggia fracture-dislocation. The patient went through open reduction beside internal fixation of the ulnar shaft via Limited Contact Dynamic Compression Plate (LC-DCP) and radio-capitellar joint reduction and provisional fixation by a pin. The patient recovered after three months with a significant increase in elbow ROM without any complications.
 Conclusion: This method could be an appropriate treatment of choice for neglected Monteggia fractures which indeed had excellent outcomes without complication.
 
 
 

Monteggia Fracture-Dislocation with Associated TFCC Injury and DRUJ Subluxation – A Very Rare Case Report

Introduction:Monteggia fracture-dislocation is defined as a proximal third ulna fracture with radiocapitellar joint dislocation. The term “Monteggia equivalent or variant” describes various injuries with similar radiographic patterns and injury biomechanics. Several isolated cases of unusual injuries associated with Monteggia fractures have been reported. However, an associated TFCC injury has not been described in the literature before. We present a rare report of a 24-year-old female with a Monteggia fracture and associated TFCC injury – a crisscross type of injury. Case Report:A 24-year-old female was involved in a road traffic accident and presented to our level I trauma center with pain and deformity in the left forearm. On evaluation, she was found to have type I Monteggia fracture-dislocation. Intraoperatively, once the proximal ulna was fixed, she had clicking in the wrist during rotations. Fluoroscopic images showed DRUJ subluxation, but it was stable in supination. Hence was splinted in a reduced position. The patient continued to have persistent symptoms in the wrist despite adequate conservative measures. Hence, she underwent arthroscopic TFCC repair and DRUJ pinning. At her last follow-up (3 months), the patient was clinically better with a good range of motion and no pain. Conclusion:In treating Monteggia fracture-dislocations, high index of suspicion is needed to diagnose radioulnar joint instability. If they are missed, they can result in long-term disability, so appropriate evaluation to diagnose TFCC and DRUJ injuries is required. DRUJ stabilization and TFCC repair can produce consistent results when treated adequately. Keywords:TFCC, monteggia, wrist, arthroscopy, proximal ulna.

The radiological findings in complex elbow fracture-dislocation injuries.

Elbow fracture-dislocation is a complex injury which can lead to significant bony and soft tissue damage. Surgical intervention is guided towards restoring joint stability, allowing early mobilization and preventing long-term joint stiffness. The most common types are posterolateral, posteromedial, Monteggia type (and variants), and anterior trans-olecranon fracture-dislocations. Posterolateral fracture-dislocation is characterized by a radial head fracture (± anterolateral coronoid fracture) and typically capsuloligamentous disruption (lateral collateral ligaments injury is the most common). A posterolateral fracture-dislocation with radial head and coronoid anterolateral facet fractures is termed a terrible triad injury. In posteromedial fracture-dislocation, there is a fracture of the anteromedial facet of the coronoid, typically with proximal avulsion of the lateral collateral ligaments (± injury to the posterior bundle of the ulnar collateral ligament). Monteggia fracture-dislocation injuries demonstrate proximal ulnar fracture (with possible involvement of the olecranon and the coronoid) and radial head dislocation. These can be divided into apex anterior or apex posterior variants. The latter are commonly associated with radial head fractures and lateral ligamentous injury, and have a worse prognosis. In trans-olecranon fracture-dislocation, there is significant disruption of the greater sigmoid notch and the olecranon, with various involvement of the coronoid and the proximal ulna. The article describes the radiological findings and outlines the management principles in complex elbow fracture-dislocation injuries.

Elbow Arthrodesis Surgical Technique.

Elbow arthrodesis is an uncommon salvage procedure indicated for failed total elbow arthroplasty, segmental bone loss near the elbow, and severe postinfectious or posttraumatic arthritis. This video demonstrates the surgical technique for elbow arthrodesis in a patient with segmental bony defect of the ulna and postinfectious and posttraumatic elbow arthritis after a severe left arm degloving injury with Monteggia fracture dislocation and radial head fracture.