Complex Monteggia Fracture - Louisiana Orthopaedic Association

Transcription

Complex Monteggia Fracture
Tyler Clark, MD, Daniel Merriott, BS,
Joseph Gonzales, MD
Disclosures
None
Tulane Orthopaedic Surgery
NF
5 yo F sustained an open forearm fracture from
a fall from height. Evaluated at OSH and
transferred to CHNOLA for higher level of care.
Plan
Patient was splinted and taken urgently to the
OR for Irrigation and Debridement with Closed
Reduction and Intramedullary Fixation
Plan
After achieving stable fixation of Ulna, Radius
unable to maintain closed reduction
Arthrogram Considered
Computed Tomography of Elbow with plans for
possible repeat operative treatment
CT Axial
CT Sagittal
CT Coronal
CT Results
Radial neck fracture with posteriorly displaced
radial head fracture
Plan: Return to OR for open reduction and
fixation
Operative Tx
Patient did well, discharged from hospital
without complication.
Pin removed in clinic at 4 weeks.
Final Xrays
Key points
Radial Head Ossification
Monteggia Type Fracture
Radial Head Ossification
Radial Head ossifies age 3-4
Patient had delayed ossification of radial head
making diagnosis difficult
Bado Classification
Bado Classification
Description of Lesion
Type I
Fracture of proximal or middle third of ulna, anterior dislocation of radial head
Type II
Fracture of proximal or middle third of ulna, posterior dislocation of radial head
Type III
Fracture of proximal or middle third of ulna, lateral dislocation of radial head
Type IV
Proximal ulna and radius fracture, with associated dislocation of radial head in any direction
Classification
Monteggia Type I Variant
1.
2.
3.
4.
Proximal Ulna Fracture
Anteriorly Dislocated Radius
Radial Neck Fracture
Posteriorly Dislocated Radial Head with
comminution
No Cases like this described in English Literature
Closest case was a Type II Fracture with
posterior head and neck fracture and
dislocation
Thank You
Bibliography
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Hughston JC. Fracture of the distal radial shaft; mistakes in management. J Bone Joint Surg Am.
1957 Apr. 39-A(2):249-64
Ha T, Grant S, Huntley JS. Monteggia type IV fracture in a child with radial head dislocation
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Ogden JA. Skeletal injury in the child. 3rd ed. New York: Springer; 2000
Reina N, Laffosse JM, Abbo O, Accadbled F, Bensafi H, Chiron P. Monteggia equivalent fracture
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deformation. Clin Orthop Relat Res. 2007 Jul;460:258-62.
Sur YJ, Park JB, Song SW. Pediatric posterior monteggia lesion: a greenstick fracture of the
proximal ulnar metaphysis with radial neck fracture. A case report. J Orthop Trauma. 2010
Feb;24(2):e12-6.
Canel ST, Beaty JH. Campbell's Operative Orthopaedics. 12th Edition. Mosby. 2013. Pg 2884-2887.
Bell Tawse AJS. The treatment of malunited anterior Monteggia fractures in children. J Bone Joint
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Complex Monteggia Fracture - Louisiana Orthopaedic Association

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