scholarly journals A New Pediatric Monteggia Fracture Type 4 Variant

2021 ◽  
Vol 11 (10) ◽  
Author(s):  
Ehab S Saleh
Keyword(s):  
Open Reduction ◽  
Fracture Dislocation ◽  
Monteggia Fracture ◽  
Radial Head Dislocation ◽  
Proximal Ulna ◽  
Joint Dislocation ◽  
Ulna Fracture ◽  
Joint Dislocations ◽  
Fracture Dislocations ◽  
Monteggia Fracture Dislocation

Introduction: Monteggia fracture-dislocations are rare and complex injuries that usually involve a fracture of the proximal ulna associated with a proximal radioulnar and radiocapitellar joint dislocations. These injuries comprise <1% of all pediatric forearm fractures. We report on a pediatric Monteggia fracture-dislocation variant that included an irreducible divergent ulnohumeral joint dislocation, an irreducible anterior radial head dislocation, and a proximal and distal radius and ulna fracture. Case Report: A 6-year-old female came to our emergency room with a right elbow and forearm pain and deformity after a fall from a slide on the same day. X-rays revealed a divergent ulnohumeral joint dislocation, an anterior radiocapitellar joint dislocation, a proximal radioulnar joint dislocation, and a proximal and distal ulna and radius fracture. Closed reduction under sedation in the emergency room was not successful, with persistent ulnohumeral, ulnoradial, and radiocapitellar joint dislocations. The patient was taken to the operating room the next morning. She underwent open reduction and internal fixation of the proximal ulna fracture with a one-third tubular locking plate, and radial head dislocation open reduction. A stable reduction of the ulnohumeral joint was only possible after the fixation of the proximal ulna fracture. The most stable position for the radiocapitellar joint after its open reduction was at 70o of elbow extension and full forearm supination; the patient was casted in that position for 6 weeks. Conclusion: Pediatric Monteggia fracture-dislocations are rare and complex childhood fractures, and new variants of this injury can have even more complex presentations. Open reduction and stable internal fixation addressing all components of this injury will lead to an excellent outcome. Keywords: Pediatric monteggia fracture-dislocation, new type four variant, divergent ulnohumeral joint dislocation, irreducible dislocation.

scholarly journals Irreducible Radial Head in Monteggia Fracture Dislocation; Is there an Alternative to Open Reduction?

2021 ◽  
Vol 4 (7) ◽  
pp. 10-15
Author(s):  
Amr A Abdelgawad ◽  
Aaron J Wey ◽  
Rami Khalifa ◽  
Saad Shoulah ◽  
Ahmed M Thabet
Keyword(s):  
Radial Head ◽  
Open Reduction ◽  
Fracture Dislocation ◽  
Monteggia Fracture ◽  
Monteggia Fracture Dislocation

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

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Ramprasad Jasti ◽  
Sunil Magadam ◽  
Sijeel Shukla ◽  
Senthilvelan Rajagopalan ◽  
Ashok Selvaraj ◽  
...  
Keyword(s):  
Road Traffic ◽  
Fracture Dislocation ◽  
Wrist Arthroscopy ◽  
Monteggia Fracture ◽  
Type I ◽  
Injury Biomechanics ◽  
Proximal Ulna ◽  
Persistent Symptoms ◽  
Level I ◽  
Monteggia Fracture Dislocation

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.

scholarly journals Successful Treatment of Chronic Monteggia Fracture-dislocations in Children---A New Reference

2021 ◽  
Author(s):  
Ping Xu ◽  
Zhiqiang Zhang ◽  
Bo Ning ◽  
Dahui wang
Keyword(s):  
Case Series ◽  
Fracture Dislocation ◽  
Monteggia Fracture ◽  
Monteggia Lesion ◽  
Ulnar Osteotomy ◽  
Fracture Dislocations ◽  
The Mean ◽  
Monteggia Fracture Dislocation ◽  
Relationship Of

Abstract BackgroundGreat difficulty and more failures were the descriptions of a chronic Monteggia fracture-dislocation. The treatment of chronic Monteggia lesion remains controversial and challenging for surgeons. This study aims to introduce our experience of a new reference in the treatment of chronic Monteggia fracture-dislocation in children and evaluate outcomes from clinical and radiographic findings.MethodsWe retrospectively reviewed 18 children who underwent surgical treatment because of chronic Monteggia lesion. Electronic medical records of clinical data, radiographic parameters, and operative details, were reviewed for study analysis. Parameters were compared at the time of pre-operation and the last follow-up. The relationship of lengthening and angulation of ulnar was calculated.ResultsMean interval time was 11.1 ± 15.7 months and follow-up time was 34.6 ± 23.7 months in this study. A congruent radiocapitellar reduction was observed in 15 (83.3%) patients, while 2 (11.1%) patients developed subluxation, and 1 (5.6%) patient had redislocation. The mean posterior bending angle was 12.88° (range, 3 to 25°), and the mean amount of elongation of the ulnar was 8.78 mm (range, 3.6 to 17.5 mm). The lengthening was significantly proportional to the magnitude of angulation of ulnar in good outcome patients (r = 0.637, p = 0.009), and the index was larger than the failed ones. Postoperatively, the Kim scores were obviously improved, from 59.17 ± 18.17 to 90 ± 6.64.ConclusionsWe highlight the ulnar osteotomy as the essential procedure during the reconstruction surgeries. Enough elongation and balanced angulation of the osteotomy is warranted to keep satisfactory outcomes. The ulnar should be lengthened to more than normal proportional ulnar length to stable the radial head reduction. Iliac crest autograft is recommended to avoid nonunion of ulnar osteotomy after enough lengthening.Level of evidenceLevel IV; Case Series; Treatment Study

scholarly journals The management of chronic paediatric Monteggia fracture-dislocation

2021 ◽  
Vol 24 ◽  
pp. 65-76
Author(s):  
Tom Gryson ◽  
Alexander Van Tongel ◽  
Frank Plasschaert
Keyword(s):  
Fracture Dislocation ◽  
Monteggia Fracture ◽  
Monteggia Fracture Dislocation

Results of Treatment of Chronic Dorsal Fracture-Dislocations of the Proximal Interphalangeal Joints of the Fingers

1998 ◽  
Vol 23 (6) ◽  
pp. 798-801 ◽  
Author(s):  
O. ISHIDA ◽  
Y. IKUTA
Keyword(s):  
Articular Cartilage ◽  
Internal Fixation ◽  
Open Reduction ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Results Of Treatment ◽  
Palmar Plate ◽  
Fracture Dislocations

We reviewed 20 cases of chronic dorsal fracture-dislocation of the proximal interphalangeal joint, with a mean follow-up period of 74 months. In patients without comminuted palmar fragments, open reduction and internal fixation or osteotomy of the malunited fragment provided good results. In treating patients with damaged articular cartilage or with comminuted palmar fragments by palmar plate arthroplasty, poor results were obtained because of secondary osteoarthritic changes.

Fractures and Fracture Dislocations of the Midfoot: Occurrence, Causes and Long-term Results

2001 ◽  
Vol 22 (5) ◽  
pp. 392-398 ◽  
Author(s):  
Martinus Richter ◽  
Burkhard Wippermann ◽  
Christian Krettek ◽  
Hanns Eberhard Schratt ◽  
Tobias Hufner ◽  
...  
Keyword(s):  
Open Reduction ◽  
Traffic Accidents ◽  
Fracture Dislocation ◽  
Long Term Results ◽  
Treatment Optimization ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Fracture Dislocations

Etiology and outcome of 155 patients with midfoot fractures between 1972 and 1997 were analyzed to create a basis for treatment optimization. Cause of injuries were traffic accidents (72.2%), falls (11.6%), blunt injuries (7.7%) and others (5.8%). Isolated midfoot fractures (I) were found in 55 (35.5%) cases, Lisfranc fracture dislocations (L) in 49 (31.2%), Chopart-Lisfranc fracture dislocations (CL) in 26 (16.8%) and Chopart fracture dislocations (C) in 25 (16%). One hundred and forty eight (95%) of the midfoot fractures were treated operatively; 30 with closed reduction, 115 with open reduction, 3 patients had a primary amputation. Seven (5%) patients were treated non-operatively. Ninety seven (63%) patients had follow-up at an average of 9 (1.3–25, median 8.5) years. The average scores of the entire follow-up group were as follows: AOFAS – sum of all four sections (AOFAS-ET): 296, AOFAS-Midfoot (AOFAS-M): 71, Hannover Scoring System (HSS): 65, and Hannover Questionnaire (Q): 63. Regarding age, gender, cause, time from injury to treatment and method of treatment no score differences were noted (t-test: p > 0.05). L, C or I showed similar scores and CL significantly lower scores (AOFAS-ET, AOFAS-M, HSS, Q). The highest scores in all groups were achieved in those fractures treated with early open reduction and operative fixation. Midfoot fractures, particularly fracture dislocation injuries, effect the function of the entire foot in the long-term outcome. But even in these complex injuries, an early anatomic (open) reduction and stable (internal) fixation can minimize the percentage of long-term impairment.

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