DOCSLIB.ORG

Monteggia Fractures: Pearls and Pitfalls Robertd3xx Cole Turner, MD,D4XX † and Christined1xx A

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Monteggia Fractures: Pearls and Pitfalls Robertd3xx Cole Turner, MD,D4XX † and Christined1xx A Monteggia Fractures: Pearls and Pitfalls RobertD3XX Cole Turner, MD,D4XX † and ChristineD1XX A. Ho, MDD2XX * The entity of Monteggia fractures describes a spectrum of fracture-dislocations in which the radiocapitellar joint becomes disrupted in association with an ulnar shaft fracture. While these injuries are relatively uncommon in the pediatric population, they pose both a diag- nostic and therapeutic challenge, as the constellation of these injuries can be subtle and difficult to identify. As such, they are often missed or neglected in the setting of a minimally displaced ulnar shaft fracture in which the radiocapitellar dislocation goes unrecognized. There is a wide spectrum of treatment strategies for pediatric Monteggia fractures, from closed reduction and immobilization in the acute setting to extensile open reconstructive techniques for chronic cases. Outcomes can be variable depending on the time of treatment and age of the patient. The most important principle for management of these injuries is early recognition and close follow-up to prevent poor outcomes. Oper Tech Orthop 29:34-42 © 2019 Elsevier Inc. All rights reserved. KEYWORDS monteggia, elbow, pediatric Introduction and therefore under-recognizes plastic deformation (Fig. 1). It is critical to restore this anatomical relationship between the proxi- fi iovanni Monteggia rst described in 1814 two cases with a mal radius and ulna to the distal humerus when treating Mon- G combined a proximal third ulna fracture and an associated teggia fractures. In the pediatric population, this relationship is 1 anterior radiocapitellar dislocation. It was not until the 1960s most often driven by the character of the ulna; however, other that Jose Bado coined the eponym known today as the Monteggia soft tissue structures may impede the restoration of the normal lesion; in his seminal manuscript, he observed other variants of anatomical architecture. the Monteggia lesion, describing ulna fractures in locations other than the proximal third and describing posterior and lateral radial head dislocations.2,3 His classification is still used today. As multiple variants of Monteggia fractures exist, it is most Epidemiology accurately described as a forearm fracture with dislocation of the 4 Pediatric Monteggia fractures are relatively uncommon. Their proximal radioulnar joint. Subtle bowing of the ulna shaft with true incidence is likely unknown, but Letts et al reported an asssociated radiocapitellar dislocation may be missed by the only 33 cases over the course of 5 years at their children's inexperienced clinician who is looking for a forearm fracture hospital in Winnipeg, Canada.5 The peak incidence in their series was in children aged 7-10. More recently, Joeris et al *Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Chil- performed a comprehensive pediatric classification of long dren and Children's Health Dallas, University of Texas Southwestern bone fractures out of Switzerland over a 2-year period. Out Medical School, Dallas, TX. y of 2292 upper extremity fractures in children, 26 were Mon- Department of Orthopaedic Surgery, Tripler Army Medical Center, teggia fractures, comprising 1.1% of cases.6 Ninety-six per- Honolulu, HI. Grant support: None cent of these were children younger than 11 years old. Institution: From Texas Scottish Rite Hospital for Children and Children's Medical Center, Dallas, Texas Financial disclosures: No conflict of interests is disclosed. Address reprint requests to Christine A. Ho, MD, Department of Orthopaedic Anatomy Surgery, Texas Scottish Rite Hospital for Children and Children's Health Dallas, University of Texas Southwestern Medical School, E2300-E2.01, 1935 The anatomical relationship of the radius and ulna is crucial Medical District Drive, Dallas, TX 75235. E-mail: [email protected] for proper rotational motion. They are held together along 34 https://doi.org/10.1053/j.oto.2018.12.007 1048-6666/© 2019 Elsevier Inc. All rights reserved. Monteggia Fractures: Pearls and Pitfalls 35 diastasis of the PRUJ, in addition to radiocapitellar incongru- ence, is necessary to diagnose a Monteggia fracture.8,9 Because of their intimate association, displaced proximal or midshaft forearm fractures of one bone frequently result in a fracture or dislocation of the other due to the nature of the high energy mechanism.4 Figure 1 Anteroposterior (AP) forearm radiographic view of an 18- The muscular anatomy contributes to the deforming forces month-old child who fell from the couch. Note the subtle apex of Monteggia fractures. In hyperextension mechanisms, the anterior bow of the ulna with radiocapitellar dislocation; this Bado biceps brachii acts to pull the proximal radius anterior rela- Type I Monteggia lesion is easily underappreciated. tive to the capitellum, which is the most common Monteggia fracture-dislocation, a Bado Type I.7 their length, distally by the distal radioulnar ligamentous Surrounding neurovascular structures may also experience complex, by the interosseous membrane along their shafts, either compression or traction injuries after Monteggia fractures, and the proximal radioulnar joint (PRUJ) at the level of the which usually result in a transient neurapraxia. Because of its rel- elbow (Fig. 2). Altering the osseous structure or any of their atively closer proximity to the radial head and neck, the poste- connections along the length of the forearm can be detrimen- rior interosseous nerve is at particular risk. tal to regaining functional arcs of motion. Specifically for cases of Monteggia fractures, the quadrate and annular liga- ments are crucial structures for maintaining reduction of the PRUJ and radiocapitellar joint.7 Some even argue that the Classification Originally described as a proximal third ulna fracture with anterior dislocation of the radial head,1 Bado was the first to thoroughly describe the 4 distinguished types of Monteggia fracture-dislocations in the series of 40 patients that he treated.2,3 In his description, the type was defined by the direction of the radial head dislocation, which is always in the direction of the apex ulnar deformity (Table 1). In Bado's series (which included both adults and chil- dren), type I was the most common at 60%, followed by type III (20%), then type II (15%), and lastly type II. In chil- dren, the majority (>60%) are type I,6,10 followed by type III; types II and IV are relatively rare in children.10,11 Bado also described several Monteggia type I equivalents; the most common of these include a fracture of the ulnar shaft associated with a fracture of the proximal radial epiphy- sis or radial neck12; and another is a pure anterior dislocation of the radial head, which likely is associated with plastic ulnar deformation.7 Mechanism of Injury Each Bado type is associated with a different type of mecha- nism of injury. Type I Monteggia fractures alone have multi- ple proposed mechanism: a direct posterior blow to ulna,1,13 body rotation around a fixed and hyperpronated forearm,3 and hyperextension during which the biceps pulls the radial Table 1 Bado’s Classification of Monteggia Fracture- Dislocations Type I Radial head is dislocated anteriorly Type II Radial head is dislocated posteriorly Type III Radial head is dislocated laterally; the ulna frac- ture is often a proximal metaphyseal green- stick fracture Type IV Radial head is dislocated anteriorly, but both the Figure 2 Volar view of the multiple ligamentous structures connec- radius and ulna are fractured ting the radius and ulna. 36 R.C. Turner and C.A. Ho head anteriorly and the ulna fractures from bearing the full problem faced in treating these children because it may lead weight of the body.14 to missed or delayed diagnosis.9,10 This is true both in the Type II fracture-dislocations occur after a flexed elbow is acute setting as well as during the follow-up period. Weis- longitudinally loaded.12 Type III result from a varus exten- man et al described 2 delayed diagnoses of Monteggia frac- sion force at the elbow.3,9 tures: initially both were isolated ulnar fractures with congruent radiocapitellar joints, but as the ulna angulated in the cast, the radial head followed and dislocated from the radiocapitellar joint.18 Diagnosis While some Monteggia patterns may show obviously dis- Evaluation of children with Monteggia fractures usually placed ulnar fractures and radiocapitellar dislocations, care reveal an obvious deformity about the proximal forearm and should be taken when assessing for subtle dissociation of the elbow.7 The child will likely have limited range of motion in proximal radioulnar joint or incongruity of the radiocapitel- both flexion-extension and pronation-supination. Depending lar joint. on the amount of radiocapitellar dissociation, there may be a Classic dogma has taught that a line drawn down the longitu- palpable radial head. It is important to have a high index of dinal axis of the radius should pass through the center of the suspicion for associated ipsilateral upper extremity injuries, capitellum in all views regardless of the amount of flexion or especially in children with Bado type II lesions.15,16 Exami- extension of the elbow.13,18 This has been described as the nation of skin should be thorough to rule out possible open radiocapitellar line, or RCL. However, the RCL may not be as fractures, and prereduction neurovascular status is important reliable as originally thought to predict the congruence of the to compare to postreduction or postoperative findings. Pedi- radiocapitellar joint and defineaMonteggiafractureoranequiv- atric patients with missed or neglected Monteggia fractures alent thereof. Silberstein et al state that the RCL may miss the may not present until they are adults. In such cases, there capitellum completely on the anteroposterior (AP) view in may be obvious elbow deformities and neurologic deficits, young child.19 Likewise, Miles and Finlay recommend caution such as cubitus valgus and tardy ulnar nerve palsy.17 in using the RCL as they identified 5 normal pediatric elbows in which this line did not intersect the capitellum.20 These authors recommend limiting the use of the RCL to the lateral radiograph.
Load more

Recommended publications
  • Listen to the Associated Podcast Episodes: MSK: Fractures for the ABR Core Exam Parts 1-3, Available at Theradiologyreview.Com O
    MSK: Fractures for Radiology Board Study, Matt Covington, MD Listen to the associated podcast episodes: MSK: Fractures for the ABR Core Exam Parts 1-3, available Listen to associated Podcast episodes: ABR Core Exam, Multisystemic Diseases Parts 1-3, available at at theradiologyreview.com or on your favorite podcast directory. Copyrighted. theradiologyreview.com or on your favorite podcast direcry. Fracture resulting From abnormal stress on normal bone = stress Fracture Fracture From normal stress on abnormal bone = insuFFiciency Fracture Scaphoid Fracture site with highest risk for avascular necrosis (proximal or distal)? Proximal pole scaphoid Fractures are at highest risk For AVN Comminuted Fracture at the base oF the First metacarpal = Rolando Fracture Non-comminuted Fracture at base oF the First metacarpal = Bennett Fracture The pull oF which tendon causes the dorsolateral dislocation in a Bennett fracture? The abductor pollicus longus tendon. Avulsion Fracture at the base oF the proximal phalanx with ulnar collateral ligament disruption = Gamekeeper’s thumb. Same Fracture but adductor tendon becomes caught in torn edge oF the ulnar collateral ligament? Stener’s lesion. IF Stener’s lesion is present this won’t heal on its own so you need surgery. You shouldn’t image a Gamekeeper’s thumb with stress views because you can convert it to a Stener’s lesion. Image with MRI instead. Distal radial Fracture with dorsal angulation = Colle’s Fracture (C to D= Colle’s is Dorsal) Distal radial Fracture with volar angulation = Smith’s Fracture (S
    [Show full text]
  • Distal Humerus Lateral Condyle Fracture and Monteggia Lesion in a 3-Year Old Child : a Case Report
    Acta Orthop. Belg., 2008, 74, 542-545 CASE REPORT Distal humerus lateral condyle fracture and Monteggia lesion in a 3-year old child : A case report Rupen DATTANI, Surendra PATNAIK, Avdhoot KANTAK, Mohan LAL From East Surrey Hospital, Surrey, United Kingdom We describe a case of a Monteggia fracture disloca- DISCUSSION tion and an ipsilateral lateral humeral condyle frac- ture in a 3-year-old child. This is a rare combination Lateral condyle physeal fractures comprise 17% of injuries with no previously reported cases in the of all paediatric distal humerus fractures with a literature. This case emphasises that when a fracture peak incidence at 6 years of age (8). The mechanism is detected around an elbow there should be a high of injury is either an avulsion by the pull of the index of suspicion for other injuries in the region. common extensor origin owing to a varus stress Keywords : Monteggia fracture dislocation ; fracture of exerted on the extended elbow (‘pull off’ theory) or the humeral condyle ; elbow dislocation ; humerus a fall onto an extended upper extremity resulting fracture. in an axial load transmitted through the forearm, causing the radial head to impinge on the lateral head (‘push off’ theory) (2). Milch classified these fractures into two types (12). In type I injuries, the CASE REPORT fracture line courses lateral to the trochlea and into the capitello-trochlear groove representing a Salter- A 3-year-old boy presented to the emergency Harris type IV fracture : the elbow is usually stable department following a fall from a height onto his because the trochlea is intact.
    [Show full text]
  • Upper Extremity Fractures
    Department of Rehabilitation Services Physical Therapy Standard of Care: Distal Upper Extremity Fractures Case Type / Diagnosis: This standard applies to patients who have sustained upper extremity fractures that require stabilization either surgically or non-surgically. This includes, but is not limited to: Distal Humeral Fracture 812.4 Supracondylar Humeral Fracture 812.41 Elbow Fracture 813.83 Proximal Radius/Ulna Fracture 813.0 Radial Head Fractures 813.05 Olecranon Fracture 813.01 Radial/Ulnar shaft fractures 813.1 Distal Radius Fracture 813.42 Distal Ulna Fracture 813.82 Carpal Fracture 814.01 Metacarpal Fracture 815.0 Phalanx Fractures 816.0 Forearm/Wrist Fractures Radius fractures: • Radial head (may require a prosthesis) • Midshaft radius • Distal radius (most common) Residual deformities following radius fractures include: • Loss of radial tilt (Normal non fracture average is 22-23 degrees of radial tilt.) • Dorsal angulation (normal non fracture average palmar tilt 11-12 degrees.) • Radial shortening • Distal radioulnar (DRUJ) joint involvement • Intra-articular involvement with step-offs. Step-off of as little as 1-2 mm may increase the risk of post-traumatic arthritis. 1 Standard of Care: Distal Upper Extremity Fractures Copyright © 2007 The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services. All rights reserved. Types of distal radius fracture include: • Colle’s (Dinner Fork Deformity) -- Mechanism: fall on an outstretched hand (FOOSH) with radial shortening, dorsal tilt of the distal fragment. The ulnar styloid may or may not be fractured. • Smith’s (Garden Spade Deformity) -- Mechanism: fall backward on a supinated, dorsiflexed wrist, the distal fragment displaces volarly. • Barton’s -- Mechanism: direct blow to the carpus or wrist.
    [Show full text]
  • Rare Presentation of a Type I Monteggia Fracture V K Peter
    88 CASE REPORT Emerg Med J: first published as 10.1136/emj.19.1.88 on 1 January 2002. Downloaded from Rare presentation of a type I Monteggia fracture V K Peter ............................................................................................................................. Emerg Med J 2002;19:88–89 DISCUSSION A rare case is reported of a Monteggia equivalent injury Any dislocation of the radial head with an ulnar fracture con- where a dislocation of the radial head is associated with stitutes a Monteggia lesion. Of the various classifications fracture of the distal third of the radius and ulna. The available, Bado’s is the one that is almost universally in use. mechanism, treatment and outcome are described. Type I: anterior dislocation of the radial head, fracture of the ulnar diaphysis at any level with anterior (volar) angulation. Type II: posterior or posterolateral dislocation of the radial head, fracture of the ulnar diaphysis with posterior (dorsal) CASE REPORT angulation. 12 year old boy fell backwards off a chair onto his Type III: lateral or anterolateral dislocation of the radial outstretched left arm. He described a twisting injury to head with fracture of the ulnar metaphysis or diaphysis. Athe arm at the time. He was seen in the accident and Type IV: anterior dislocation of the radial head, fracture emergency department with an obvious deformity of the dis- proximal third radius and fracture of the ulna at the same tal forearm and tenderness over the ipsilateral elbow. level.1 Movements at the wrist and elbow were painful and Letts classified such fractures in children into five groups. A restricted, and no neurological or vascular deficits were noted.
    [Show full text]
  • Fractures of the Proximal Ulna: Current Concepts in Surgical Management
    3.1800EOR0010.1302/2058-5241.3.180022 research-article2019 EOR | volume 4 | January 2019 DOI: 10.1302/2058-5241.3.180022 Trauma www.efortopenreviews.org Fractures of the proximal ulna: current concepts in surgical management Sebastian Siebenlist1 Arne Buchholz2 Karl F. Braun2 Fractures of the proximal ulna range from simple olec- or Monteggia-like lesions involving damage to stabilizing ranon fractures to complex Monteggia fractures or key structures of the elbow (i.e. coronoid process, radial Monteggia- like lesions involving damage to stabilizing key head).1,2 While these fractures are common injuries in the structures of the elbow (i.e. coronoid process, radial head, upper extremity at any age, in adults they peak during the collateral ligament complex). seventh decade of life.3 The anatomical restoration of In complex fracture patterns a computerized tomography ulnar alignment (in length, rotation and axis) has to be the scan is essential to properly assess the injury severity. primary goal of surgical treatment to regain an unre- stricted elbow function. Thus, the surgeon carefully needs Exact preoperative planning for the surgical approach is to address all aspects of the injury to allow early (active) vital to adequately address all fracture parts (base coro- rehabilitation and thereby prevent elbow stiffness.4 An noid fragments first). improper osseous reconstruction of the ulna as well as a The management of olecranon fractures primarily comprises failed/missed reattachment of elbow stabilizing structures tension-band wiring in simple fractures as a valid treatment will otherwise result in persistent pain, poor function and option, but modern plate techniques, especially in commi- progressive joint degeneration due to chronic elbow nuted or osteoporotic fracture types, can reduce implant instability.5 Consequently, the appropriate treatment of failure and potential implant-related soft tissue irritation.
    [Show full text]
  • Ipsilateral Supracondylar Fracture and Forearm Bone Injury in Children: a Retrospective Review of Thirty One Cases
    Original Article VOL.9 | NO. 2 | ISSUE 34 | APR - JUN 2011 Ipsilateral Supracondylar Fracture and Forearm Bone Injury in Children: A Retrospective Review of Thirty one Cases Dhoju D, Shrestha D, Parajuli N, Dhakal G, Shrestha R Department of Orthopaedics and traumatology ABSTRACT Dhulikhel Hospital-Kathmandu University Hospital Background Dhulikhel, Nepal Supracondylar fracture and forearm bone fracture in isolation is common musculoskeletal injury in pediatric age group But combined supracondylar fracture with ipsilateral forearm bone fracture, also known as floating elbow is not common injury. The incidence of this association varies between 3% and 13%. Since the Corresponding Author injury is rare and only limited literatures are available, choosing best management options for floating elbow is challenging. Method Dr Dipak Shrestha In retrospective review of 759 consecutive supracondylar fracture managed in Department of Orthopaedics and traumatology between July 2005 to June 2011, children with combined supracondylar fracture Dhulikhel Hospital-Kathmandu University Hospital with forearm bone injuries were identified and their demographic profiles, mode of injury, fracture types, treatment procedures, outcome and complications were Dhulikhel, Nepal. analyzed. E-mail: [email protected] Result Thirty one patients (mean age 8.91 yrs, range 2-14 yrs; male 26; left side 18) had Mobile No: 9851073353 combined supracondylar fracture and ipsilateral forearm bone injury including four open fractures. There were 20 (64.51%) Gartland type III (13 type IIIA and 7 type III B), seven (22.58 %) type II, three (9.67 %) type I and one (3.22 %) flexion Citation type supracondylar fracture. Nine patients had distal radius fracture, six had distal third both bone fracture, three had distal ulna fracture, two had mid shaft both Dhoju D, ShresthaD, Parajuli N, Dhakal G, Shrestha R.
    [Show full text]
  • Nonoperative Management of Pediatric Upper Extremity Fractures Or ‘Don’T Throw Away the Cast’
    Techniques in Orthopaedics® 20(2):115–141 © 2005 Lippincott Williams & Wilkins, Inc., Philadelphia Nonoperative Management of Pediatric Upper Extremity Fractures or ‘Don’t Throw Away the Cast’ Kaye E. Wilkins, D.V.M., M.D. Summary: With the exception of fractures involving the distal humerus, almost all fractures of the upper extremity can be successfully treated by noninvasive methods. The surgeon treating upper extremity fractures in children in areas of developing nations where the medical and surgical resources are limited should have a good knowledge of the nonoperative techniques available. He or she should also be skilled in administering local and regional anesthesia. Fortunately, in the pediatric age group, there is a considerable remodeling potential. This fact determines the adequacy of the best reduction that can be obtained by nonoperative methods. Knowledge of the limits of satisfactory remodeling for the various fracture patterns is also essential. Anyone treating fractures in these areas needs to be flexible with their approach and innovative in their methods. Although these fractures often present challenges for the treating physician, they can provide a great deal of satisfaction when they are conquered and the patient’s fracture treatment has a successful outcome. The specific techniques for the nonoperative management of upper extremity fractures in the pediatric patient are discussed in detail. It must be emphasized, however, that the treating surgeon should both teach and perform procedures to achieve as satisfactory a reduction as possible within the resources of the local area. Key Words: Fractures—Nonoperative— Conservative—Casts. Emphasis on Surgery nations. Likewise, the implants are expensive and thus are In the United States, there has been an increasing rarely available.
    [Show full text]
  • The Results of Treatment in Pediatric Monteggia Equivalent Lesions Çocuklardaki Monteggia Eşdeğer Lezyonlarında Tedavi Sonuçları
    ACTA ORTHOPAEDICA et Author’s translation TRAUMATOLOGICA Acta Orthop Traumatol Turc 2008;42(2):90-96 TURCICA The results of treatment in pediatric Monteggia equivalent lesions Çocuklardaki Monteggia eşdeğer lezyonlarında tedavi sonuçları Melih GUVEN,1 Abdullah EREN,2 Baris KADIOGLU,2 Umut YAVUZ,2 Volkan KILINCOGLU,3 Korhan OZKAN2 1The Hospital of University of Abant Izzet Baysal, Department of Orthopaedics and Traumatology; 2Göztepe Training and Research Hospital, 2nd Orthopaedics and Traumatology Clinic; 3Fatih Sultan Mehmet Training and Research Hospital, Orthopaedics and Traumatology Clinic Amaç: Monteggia eşdeğer lezyonlu çocuklarda konserva- Objectives: We evaluated the results of conservative and sur- tif ve cerrahi tedavi sonuçları değerlendirildi. gical treatment of pediatric Monteggia equivalent lesions. Çalışma planı: Çalışmaya, Monteggia eşdeğer kırıklı- Methods: The study included 13 children (3 females, 10 çıkığı nedeniyle tedavi edilen 13 çocuk hasta (3 kız, 10 er- males; mean age 8 years; range 4 to 13 years) who under- kek; ort. yaş 8; dağılım 4-13) alındı. Yedi hastada (%53.9) went treatment for Monteggia equivalent lesions. Seven pa- Bado tip 1, altı hastada (%46.2) ise tip 3 eşdeğer lezyon tients (53.9%) had Bado type 1 and six patients (46.2%) had vardı. Tip 3 eşdeğer lezyonlu hastaların ikisinde aynı za- type 3 equivalent lesions. Two patients with type 3 equiva- manda humerus lateral kondil kırığı saptandı. Bir hastada lent lesions also had a lateral humeral condyle fracture. On (%7.7) radial sinir felci vardı. Açık kırıklı-çıkık nedeniyle presentation, one patient (7.7%) had radial nerve palsy. Pri- acil debridman ve irigasyon uygulanan bir hasta dışında, marily, closed reduction was attempted in all the patients ex- tüm hastalarda öncelikle kapalı redüksiyon denendi.
    [Show full text]
  • Shoulder Pain and Weakness Due to Rotator Cuff Muscle/Tendon Or Biceps
    Fractures of the Forearm Bones The forearm is the area between the elbow and the wrist. It has two bones. The ulna bone starts at the point of the elbow and is well fixed as a hinge to the humerus (upper arm bone). The ulna bone can be felt beneath the skin as it extends all the way from the tip of the elbow down to the little finger side of the wrist. The radius bone spins around the ulna bone and can be felt at the wrist on the thumb side. It is called the radius because it spins around the ulna bone and allows a twisting motion of the wrist. The most common mechanism of fracture of the forearm bones is a fall onto an outstretched hand, or a direct blow of a hard object against the forearm. After an injury, significant deformity of the forearm reveals that there is a fracture. Significant pain and swelling is usually present. Occasionally nerve and blood vessel injuries can result from such a fracture. Fractures of the radius bone at the wrist are very common, and will be discussed in a different section of this website. The remaining fractures of the forearm include fractures of the radial shaft, fractures of the shaft of both the radius and the ulna, and fractures of the ulna alone. Radial Shaft Fractures Radial shaft fractures, without fracture of the ulna, are not very common. When this happens, sometimes the end of the ulna is dislocated at the level of the wrist. This deformity is known as a Galeazzi fracture.
    [Show full text]
  • Anterior Dislocation of the Radial Head with Fractures of the Olecranon and Radial Neck in a Young Child a Monteggia Equivalent Fracture-Dislocation Variant
    CASE REPORT Anterior Dislocation of the Radial Head With Fractures of the Olecranon and Radial Neck in a Young Child A Monteggia Equivalent Fracture-Dislocation Variant David E. Ruchelsman, MD,* Jeffrey A. Klugman, MD,* Sanjeev S. Madan, MD,† and Gail S. Chorney, MD† lesions, suggesting that equivalent lesions may be more com- Summary: We present a case of a type I Monteggia equivalent mon than previously thought.11–14 Although early diagnosis lesion in a 7-year-old child consisting of anterior dislocation of the and closed reduction of Type I Monteggia lesions usually yield radial head, radial neck fracture, and a fracture of the olecranon good to excellent results,2,4,5,9,10,15,16 Olney and Menelaus8 without an associated fracture of the ulnar diaphysis or metaphysis. suggested that type I equivalent injuries may require open After a review of the literature, we report this fracture pattern as reduction and internal fixation. a rare type I Monteggia equivalent fracture-dislocation variant. This We report a case of a child with a rare type I Monteggia report describes delayed surgical treatment and outcome after close equivalent fracture-dislocation requiring operative manage- follow-up of a rare type I Monteggia equivalent lesion. Diagnostic ment following failure of closed reduction. challenges with and treatment options for pediatric Monteggia equivalent fracture-dislocations are discussed. Key Words: children, Monteggia fracture-dislocation, olecranon CASE REPORT fracture, radial neck fracture, type I Monteggia equivalent lesion A 7-year-old right-hand-dominant male presented to our in- stitution 6.5 weeks after sustaining a hyperextension injury to his (J Orthop Trauma 2005;19:428–428) right elbow after falling on an outstretched forearm.
    [Show full text]
  • Upper Extremity Fracture Eponyms
    What's in a name? Upper extremity fracture eponyms (Part 1) Philip Kin-Wai Wong, Emory University Tarek Hanna, Emory University Waqas Shuaib, Emory University Stephen Sanders, Emory University Faisal Khosa, Emory University Journal Title: International Journal of Emergency Medicine Volume: Volume 8, Number 1 Publisher: SpringerOpen | 2015-12-03, Pages 75-75 Type of Work: Article | Final Publisher PDF Publisher DOI: 10.1186/s12245-015-0075-2 Permanent URL: https://pid.emory.edu/ark:/25593/q4b4k Final published version: http://dx.doi.org/10.1186/s12245-015-0075-2 Copyright information: © Wong et al. 2015 This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/). Accessed October 1, 2021 8:34 AM EDT Wong et al. International Journal of Emergency Medicine (2015) 8:27 DOI 10.1186/s12245-015-0075-2 REVIEW Open Access What's in a name? Upper extremity fracture eponyms (Part 1) Philip Kin-Wai Wong1, Tarek N. Hanna2*, Waqas Shuaib3, Stephen M. Sanders4 and Faisal Khosa2 Abstract Eponymous extremity fractures are commonly encountered in the emergency setting. Correct eponym usage allows rapid, succinct communication of complex injuries. We will review both common and less frequently encountered extremity fracture eponyms, focusing on imaging features to identify and differentiate these injuries. We focus on plain radiographic findings, with supporting computed tomography (CT) images. For each injury, important radiologic descriptors are discussed which may need to be communicated to consultants. Aspects of management and follow-up imaging recommendations are included. This is a two-part review: Part 1 focuses on fracture eponyms of the upper extremity, while Part 2 covers fracture eponyms of the lower extremity.
    [Show full text]
  • Clinical Course of Treatment of Proximal One Third Ulna Fracture By
    International Journal of Orthopaedics Sciences 2019; 5(4): 124-129 E-ISSN: 2395-1958 P-ISSN: 2706-6630 IJOS 2019; 5(4): 124-129 Clinical course of treatment of proximal one third ulna © 2019 IJOS www.orthopaper.com fracture by plate osteosynthesis in skeletally mature Received: 09-08-2019 Accepted: 13-09-2019 individuals Dr. Anand Gupta Resident, Orthopaedics Dr. Anand Gupta, Dr. Saurabh Khare, Dr. Arun Gulati, Dr. Shah Meghal Maharaja Agrasen Hospital, New Delhi, India Gautambhai and Dr. Puneet Kamra Dr. Saurabh Khare DOI: https://doi.org/10.22271/ortho.2019.v5.i4c.1659 Resident, Orthopaedics Maharaja Agrasen Hospital, Abstract New Delhi, India Objective: To study the clinical course including radiological union, fracture union time and functional outcome of plate osteosynthesis for proximal one third ulna fracture in skeletally mature individuals. Dr. Arun Gulati Method: 30 patients of proximal ulna fractures who were treated by plate osteosynthesis were included Senior Resident, Orthopaedics Kalpana Chawla Govt. Medical in this study. College, Karnal, Haryana, India Result: 30 patients were followed up for minimum duration of 6 months and the clinical outcomes were assessed according to the Mayo Elbow Performance Score (MEPS). Out of 30, our study included 21 Dr. Shah Meghal Gautambhai olecranon fractures and 9 monteggia fractures. At final follow up of 6 month, our case series of olecranon Senior Resident, Orthopaedics fractures resulted mean MEPS of 89.3with 57.1% excellent results and 42.9 % good results, and all Sanjay Gandhi Memorial, patients returning to pre-injury daily activities. For monteggia fractures, resulted mean MEPS score is New Delhi, India 93.8 with 88.9% excellent result & 11.1 % good results.
    [Show full text]