1/44. Tardy displacement of traumatic radial head dislocation in childhood. The diagnosis of traumatic dislocation of the radial head, either isolated or as part of a Monteggia fracture-dislocation, was delayed in 10 of the 110 children treated with these injuries during the study period. In eight children, the dislocation was overlooked on the initial radiographs. In two children, the radial head was reduced on the initial elbow radiographs, but it was dislocated 10 days later in one child and 21 days later in the other. The most likely explanation is that the radial head dislocated at the time of impact, spontaneously reduced by the time the first radiographs were obtained, and redislocated while the arm was in a cast. We conclude that radiographic assessments of the radiocapitellar joint, by using the radiocapitellar line, are required in children with elbow and forearm injuries at presentation and when the cast is removed. ( info) |
2/44. Complications in the management of complex Monteggia-equivalent fractures in adults. We report five adult patients with complex Monteggia-equivalent fractures who were surgically treated, all of whom had significant complications. All ulnar fractures and three radial fractures developed nonunion. Three patients required more than two procedures to achieve bony union, and one required a total elbow arthroplasty. ( info) |
3/44. adult monteggia fracture with ipsilateral distal radius fracture: case report. Although the adult Monteggia fracture is a well-known injury, the combination of a Monteggia fracture and an ipsilateral distal radius fracture is extremely rare. It is important for the treating physician to recognize that this injury involves not only the bone elements but also their articulations. The distortion of the integrity of both the elbow and the wrist results in the potential for functional compromise, if inadequately treated. The case report presented here describes a 21-year-old woman with this complex injury resulting from a fall. The injury included a Monteggia type II fracture and an ipsilateral distal radius intra-articular fracture in the left forearm. An excellent result was obtained by surgical intervention in both the radial and ulnar bones. The factors we believe contributed to the excellent result were early diagnosis, anatomic reduction, stable fixation, and early physical exercise. The mechanism of injury giving rise to this rare combination of fractures is discussed, as well as a review of the literature. ( info) |
4/44. Type II Monteggia lesion with fracture-separation of the distal physis of the radius. We report a rare case of a type II Monteggia lesion with fracture-separation of the distal physis of the radius in a 12-year-old boy and discuss the mechanism of this injury. ( info) |
5/44. Comminuted Monteggia fracture-dislocation--a technique for restoration of ulnar length: case reports. A technique to aid the reconstruction of the ulna in case of comminuted Monteggia fracture-dislocation is presented. This involves reducing the proximal radioulnar joint and temporarily transfixing the radial head to the ulna by 1 or 2 Kirschner (K) wires to establish the ulnar length. Once ulnar length has been defined, reconstruction of the comminuted ulna fracture is simplified. The radioulnar K-wires are then removed and the radioulnohumeral joint is tested for stability. This technique has been used in 6 cases of type-1 Monteggia fracture-dislocation with no subsequent malunion of the ulnar fracture or redislocation' of the radial head. After an average of 13 months follow-up, all patients had nearly full range of motion of the elbow joint. ( info) |
6/44. Anterior interosseous nerve injury associated with a Monteggia fracture-dislocation. A case of an anterior interosseous nerve palsy associated with a Monteggia fracture-dislocation is presented. The fracture of the ulna was reduced and stabilized with a plate, and the proximal radioulnar dislocation was also reduced. The nerve recovery was spontaneous and complete. A satisfactory result was obtained, without pain or functional sequelae. ( info) |
7/44. Orthopedic pitfalls in the ED: Galeazzi and Monteggia fracture-dislocation. Occult dislocations at the wrist and elbow frequently accompany forearm fractures. When left unrecognized and untreated, these injuries lead to a high incidence of long-term functional disability and chronic pain. emergency medicine practitioners need to be vigilant for both Galeazzi (distal radius fracture with radioulnar joint disruption), and Monteggia (proximal ulna fracture with radial head dislocation) fracture-dislocations. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner. ( info) |
8/44. Missed chronic anterior Monteggia lesion. Closed reduction by gradual lengthening and angulation of the ulna. Two consecutive cases of chronic dislocation of the head of the radius after missed Bado type-I Monteggia lesions are presented. Reduction was successfully achieved in both patients after ulnar corticotomy, gradual lengthening and angulation of the ulna using an external fixator. Open reduction or reconstruction of the radio-ulnar capitellar joint was not undertaken. The age at injury was seven years in the older and two years in the younger patient. The time from injury to treatment was five years in the older and three months in the younger child. At follow-up, nine years after completion of treatment in the older and eight months in the younger patient, both show satisfactory movement, function of the forearm and reduction of the head of the radius. This technique may be considered in missed Monteggia lesions before open procedures on the radio-ulnar capitellar joint are undertaken. ( info) |
9/44. Type I Monteggia fracture dislocation associated with ipsilateral distal radial epiphyseal injury. SUMMARY: Ipsilateral elbow and wrist injuries are rare in children. We present a previously undescribed case of a Bado Type I Monteggia fracture with a Salter-Harris Type II epiphyseal injury of the distal radius. A satisfactory result was achieved but required surgical intervention. Complete diagnostic evaluation is imperative to avoid missed injuries and achieve satisfactory outcome. ( info) |
10/44. Three epiphyseal fractures (distal radius and ulna and proximal radius) and a diaphyseal ulnar fracture in a seven-year-old child's forearm. SUMMARY: The authors report a rare case of fracture separations at both ends of the radius combined with an epiphyseal and diaphyseal fracture of the ipsilateral ulna. A seven-year-old girl fell one story and sustained a closed injury of her forearm. A closed reduction was unsuccessful, and an open reduction was performed with three of the four fractures being secured with Kirschner wires. These wires were removed one month later, and range-of-motion exercises were started. Thirty months after surgery, both forearms were equal in length, although the proximal radial epiphyseal line appeared partially closed. Joint motions, including forearm rotation, were normal. Radiologically, the ulnar diaphysis and the radial neck were posteriorly convex 20 degrees and 18 degrees, respectively. ( info) |