Monteggia fractures in pediatric and adult populations. Successful strategies for managing monteggia injuries. Accurate reduction of the radiocapitellar joint is crucial to prevent significant longterm consequences and failed closed reduction requires open reduction. Early recognition and appropriate management are essential to. Monteggia injury is an ulnar fracture or traumatic anterior bowing associated with proximal radioulnar joint pruj and radiocapitellar joint dislocation. Apr 19, 2019 fraktur galeazzi pdf there are several mnemonics for the difference between a galeazzi and a monteggia fracturedislocation. Type i monteggia lesion and associated fracture of the distal. Type i monteggia lesion and associated fracture of the distal radius and ulna metaphysis in a child volume 9 issue 5 noel peter, sein myint skip to main content accessibility help we use cookies to distinguish you from other users and to provide you with a better experience on our websites. Fractura monteggia galeazzi codo articulaciones free.
Mar 17, 2014 although previously reported, ipsilateral monteggia fracture dislocation and distal radius fracture in a child is still a rare occurrence. Simultaneous monteggia injuries of the elbow and ipsilateral distal radius and ulna fractures are very rare. A unique case of a type i monteggia fracture equivalent with ipsilateral fracture of the distal radius and ulna salterharris type ii in a child is reported. A case report, journal of bone and joint surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. We attempted to preserve radial length in all our patients, and supplemented the ulnar. Three years previous to this accident, the patient had sustained a galeazzi fracture of the left forearm figure 2. Such fractures are easily overlooked due to the prominence of the ulna fracture.
The difficulties encountered in the treatment of the posterior monteggia fracturedislocation have been well described. A full clinical examination may be difficult but should not be. Monteggia described a fracture of the proximal third of the ulna with. Although previously reported, ipsilateral monteggia fracture dislocation and distal radius fracture in a child is still a rare occurrence. A full clinical examination may be difficult but should not be ignored. The case we report concerns a years old boy, examined 8 days after injury. During the past twelve years thirtyfour articles dealing with this subject have appeared in the literature, and of these only two have been in english. Fall on an outstretched hand with the forearm in excessive pronation hyperpronation injury. Fraktur galeazzi pdf there are several mnemonics for the difference between a galeazzi and a monteggia fracturedislocation. This eponym is among the most widely recognized by orthopaedic surgeons.
Treatment of this injury must be orthopaedic in childhood. Full text full text is available as a scanned copy of the original print version. Monteggia in children pediatric presentation is very unique characteristics include. Full length forearm radiographs are ideal but proper limb positioning may be difficult. This eponym is among the most widely recognized by orthopaedic surgeons, largely because of the notoriously poor results associated with the treatment of these injuries, particularly in adults 8, 39, 48. The monteggia lesion europe pmc article europe pubmed central. He defined it as a traumatic lesion featuring a fracture of the proximal ulna and an anterior dislocation of the proximal epiphysis of the radius.
Considering the traumatic mechanism, monteggia fracture results from a direct impact on the ulnar diaphysis, producing dislocation of the radial head, and indirect shock by falling on the hand, with the wrist in extension. Use of intramedullary stacked nailing in the reduction of. Aug 16, 2014 fractures of the proximal third of the ulna and radius with associated anterior radial head dislocation are uncommon in children. Jun 04, 2019 fraktur galeazzi pdf there are several mnemonics for the difference between a galeazzi and a monteggia fracturedislocation. The classic monteggia fracture consists of an ulnar fracture combined with a dislocation of the radial head. Considering the traumatic mechanism, monteggia fracture results. Traumatic isolated radial head dislocation in children. Regarding the mechanism of monteggia lesion, in 14 cases 32% it was caused by highenergy fracture in young patients file. A case report, journal of bone and joint surgery on deepdyve, the largest online rental service for scholarly research with thousands of. Monteggia lesion as a fracture of the proximal ulna distal to the end of the olecranon process with an associated dis location of the radiocapitellar joint. Unusual combination of monteggia, radius shaft, and scaphoid. Monteggialike lesions treatment strategies and oneyear. Pdf how to approach monteggialike lesions in adults.
Their treatment is exclusively surgical and should be proposed early in order to restore the anatomy of the antebrachial. Fractures of the forearm with dislocation of the proximal radioulnar joint are known as monteggia fractures 2, 6, 8, 47. Simultaneous type ii monteggia lesion and fracture separation of the lower radial epiphysis. A type iv monteggia injury with a distal diaphyseal fracture in a child. Homolateral combined fractures of monteggia and galeazzi are very rare. In type iia, the fracture of the ulna involves the distal part of the olecranon and the coronoid process. Monteggia type iv fracture in a child with radial head dislocation irreducible by closed means.
Monteggialike lesions in adults treated with radial head. The mechanism of injury in the posterior monteggia lesion resembles that of a posterior elbow dislocation, in which failure oc curs through the proximal ulna rather. We present the case of a 3yearold caucasian boy who attended the emergency department. The main goal in treatment of monteggia fractures is the successful reduction of luxation of the radial head and effective retention. Monteggia lesions of the paediatric elbow, albeit uncommon, should be considered in all forearm fractures. Ipsilateral acute monteggia lesion and malunion of. Here we have described the management of a rare type iv lesion in which there was. Get a printable copy pdf file of the complete article 259k, or click on a page image below to browse page by page. Monteggia lesion, defined as an associated fracture at any segment of the ulna associated to a radial head dislocation is a recognized serious injury, however rare. Monteggia lesion, or watsonjones extension fracture combined with anterior dislocation of the radial. Xray of the right forearm showing a previously missed monteggia fracture. Only 81 cases were reported in the literature to our knowledge.
Monteggia lesion with fracture of radius shaft and an ipsilateral navicular fracture is presented. Apr 16, 2011 in a monteggia fracture dislocation, it is important to reduce the ulnar fracture completely. Jan 27, 2019 fraktur galeazzi pdf posted on january 27, 2019 by admin there are several mnemonics for the difference between a galeazzi and a monteggia fracturedislocation. Ipsilateral acute monteggia lesion 17 dislocation of the distal radioulnar joint figure 1. The isolated dislocation of the radial head is frequently described in the lesion of monteggia. A characteristic lesion was observed, consisting of a proximal ulna fracture with a triangular or quandrangular fracture at or near the level of the coronoid.
Unstable fracturedislocations of the forearm monteggia and galeazzi lesions. The posterior monteggia lesion with associated ulnohumeral. Pdf monteggialike lesions treatment strategies and oneyear. The original injuries may be missed in up to 33% of cases, and late loss of reduction following closed treatment can be seen in up to 20% of cases. Fracture of the ulna associated with dislocation of the head of the radius was described by monteggia in 1814 and is often called by his name. The posterior monteggia lesion article pdf available in journal of orthopaedic trauma 54. Monteggia fracturedislocation treated between the year 1990 and 2003. A unique case of a type i monteggia fracture equivalent with ipsilateral fracture. A monteggia fracture consists by definition of a fracture of the ulna with ligamentous failure of the proximal radius resulting in dislocation of the radial head 1, 2. Pdf thirteen posterior monteggia fracturedislocations in adults were. Fractures of the proximal third of the ulna and radius with associated anterior radial head dislocation are uncommon in children. Various reports attest to its rarity, while recording the many variant of this injury. The monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius.
Typei extension injury is a fracture of ulnar diaphysis at upper third level with anterior. The monteggia lesion is named after giovanni battista monteggia, who first reported it in 1814. We report the case of a fouryearold caucasian boy in whom the plastic deformation of the proximal ulna was reduced, and this reduction was maintained, using intramedullary stacked nailing. Correct early diagnosis is essential to avoid elbow dysfunction and the necessity for open reduction of the radial head. This retrospective analysis of 220 forearm fractures in children shows.
The influence of lateral and anterior angulation of the proximal ulna on the treatment of a monteggia fracture. Get a printable copy pdf file of the complete article 190k, or click on a page image below to browse page by page. They have concluded that the clinical outcome of this fracture remains unpredictable. He defined it as a traumatic lesion featuring a fracture of the proximal ulna and an anterior dislocation of. The monteggia fracture can be considered a rare injury, as it accounts for only 2 to 5% of all proximal forearm fractures. Only 81 cases were reported in the literature to our.
The eponym monteggia fracture includes various patterns of complex fracturedislocations of the proximal ulna and radius. We describe the management of this unique fracture and discuss the possible mechanism of injury. Anatomic reduction, rigid fixation specific attention to the contour of the ulna grechenig w, clement h, pichler w, tesch np, windisch g. Extensive plastic deformation of the proximal ulna may make reduction by closed manipulation impossible. The results were satisfactory in 29 patients, intermediate in 4 cases and poor in the 2 remaining ones. May 30, 2019 fraktur galeazzi pdf posted on may 30, 2019 by admin there are several mnemonics for the difference between a galeazzi and a monteggia fracturedislocation. However it can be a rare isolated pattern of injury in children. Extensive plastic deformation of the proximal ulna may make reduction by closed manipulation. Monteggia type iv fracture in a child with radial head. In a monteggia fracture dislocation, it is important to reduce the ulnar fracture completely.
For the fixation of the ulnar fracture, osteosynthesis with a 3. Their results show a very good correlation between the range of. A characteristic lesion was observed, consisting of a proximal ulna. Simultaneous monteggia type i fracture equivalent with. Full text is available as a scanned copy of the original print version. Jupiter further classified the posterior monteggia lesion bado type ii depending on the location and type of the ulnar fracture as well as the pattern of radial head injury. Xray of the right forearm on the 12th day following surgery.
Early recognition and appropriate management are essential to prevent longterm consequences of loss of forearm rotation, cubitus valgus, elbow instability and chronic pain. The monteggia like lesion, a variant of the monteggia fracture with a fracture of the. Thirteen posterior monteggia fracturedislocations in adults were treated surgically at the massachusetts general hospital from 1980 to 1988. It classically involves an isolated fracture of the. Monteggia fractures consist of an ulna fracture accompanied by radial head dislocation. Unusual combination of monteggia, radius shaft, and. The association of monteggia lesions with other ipsilateral fractures of the upper limb was observed in seven patients with bado type i 58% and in two patients with bado type ii 8%. Plastic deformation associated with anterior radial head dislocation 31%. Monteggia fracture dislocation international journal of. Homolateral combined fracture of monteggia and galeazzi.
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