![]() ![]() ALR seems to be indicated in chronic Monteggia fractures with normal bony alignment, without conclusive evidence on a preferable surgical technique.Īnnular ligament Annular ligament reconstruction Chronic Monteggia lesion Modified Bell Tawse technique Radial head instability Triceps autograft. A modified Bell Tawse surgical technique resulted to be effective in the presented case. An extended midline posterior approach will allow. ![]() ALR has been advocated to address radial head instability both combined with ulna osteotomy and as a single procedure, with several surgical techniques described and controversial results reported. Surgical goals include anatomic repair of the ulno-humeral articulation as well as the radiocapitellar joint. Nonetheless, bony alignment of the ulna is confirmed to be the most relevant feature to address in chronic Monteggia fractures. The annular ligament has a critical role in radial head stability. Little data exist on chronic Monteggia injury in the adult population. A case of an ALR in chronic Monteggia injury using a modified Bell Tawse surgical technique with triceps tendon autograft is presented. Relevant articles on annular ligament anatomy and biomechanics, clinical-radiographic evaluation of chronic Monteggia lesions and surgical techniques for ALR were reviewed. The aim of the present study is to investigate indications and surgical technique for annular ligament reconstruction (ALR) in chronic Monteggia fractures. This situation may lead to elbow pain, decreased motion, neurologic problems and valgus deformity. The cause may reside in residual ulnar deformity after internal fixation, in failure of annular ligament healing, or both. Several surgeries may be needed to correct this type of fracture as it is almost always a very complex fracture that requires a skilled orthopedic surgeon, usually a specialist familiar with this type of injury.Chronic Monteggia fracture is defined as dislocation of the radial head that is still present 4 weeks after injury. Ĭomplications of ORIF surgery for Monteggia fractures can include non-union, malunion, nerve palsy and damage, muscle damage, arthritis, tendonitis, infection, stiffness and loss of range of motion, compartment syndrome, audible popping or snapping, deformity, and chronic pain associated with surgical hardware such as pins, screws, and plates. In adults, the healing is slower and results usually not as good. ![]() If diagnosis is delayed, reconstructive surgery is needed and complications are much more common and results poorer. In children, the results of early treatment are always good, typically normal or nearly so. The elbow joint is particularly susceptible to loss of motion. It promotes stability of the radial head dislocation and allows very early mobilisation to prevent stiffness. Osteosynthesis (open reduction and internal fixation) of the ulnar shaft is considered the standard of care in adults. Monteggia fractures may be managed conservatively in children with closed reduction (resetting and casting), but due to high risk of displacement causing malunion, open reduction internal fixation is typically performed. IV - Combined type (5%) - ulna shaft and radial shaft are both fractured and radial head is dislocated, typically anteriorly.III - Lateral type (20%) - ulna shaft angulates laterally (bent to outside) and radial head dislocates to the side.II - Flexion type (15%) - ulna shaft angulates posteriorly (flexes) and radial head dislocates posteriorly.I - Extension type (60%) - ulna shaft angulates anteriorly (extends) and radial head dislocates anteriorly.There are four types (depending upon displacement of the radial head): Bado Classification - Monteggia Fractures It is called a 'nightstick fracture'.ĭiagnosis Classification Such an isolated ulnar shaft fracture is not a Monteggia fracture. In this context, isolated ulnar shaft fractures are most commonly seen in defence against blunt trauma (e.g. Direct blow on back of upper forearm would be a very uncommon cause.Depending on the impact and forces applied in each direction, degree of energy absorption determines pattern, involvement of the radial head and whether or not open soft tissue occurs. The ulna fractures in the proximal one-third of the shaft due to extreme dislocation. Fall outstretched hand with the forearm in excessive pronation (hyper-pronation injury).It is named after Giovanni Battista Monteggia. The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius. X-ray of Monteggia fracture of right forearm Medical condition Monteggia fracture-dislocation ![]()
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