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Monteggia Fracture – Fracture Of Shaft of Ulna With Radial Head Instability

May 14, 2009 By 1 Comment

Fractures of the ulna with associ ated dislocation of the radial head are rare injuries in adults.  they are also termed as  Monteggia fractures after the surgeon who described the injury in early 19th century.

These injuries are more common in children and exact incidence in adults is unknown.

Clinical Presentation
The patient usually present with pain and swelling of the elbow and of upper third of forearm.  Often the radial head can be palpatedone can palpate the dislocated radial head.

The affected limb should be carefully examined for any neurological deficit and vascular deficit.Radial nerve injuries  are commonly associated with Monteggia fractures. [Read more...]

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Xray of Monteggia Fracture Dislocation

May 4, 2009 By Leave a Comment

Fracture of ulna with dislocation of radial head is known as Monteggia fracture dislocation [compare with Galeazzi fracture dislocation where radial fracture is accompanied by distal radio ulnar joint instability].

Unlike Galleazzi fracture Monteggia is more common in children but occurs in adults too.

monteggia-fracture-dislocation

Monteggia Fracture Dislocation

The xray in picture belongs to 35 year old male who sustained this injury after fall from stairs. he had comminuted fracture of ulna and radial head dislocation. Not that radial head dislocation is visible in one view only. Therefore it is necessary to have xrays in both planes.

Moreover, if the elbow region is not visible in the xray, it could have been simply treated as fracture of ulna, only to discover dislocation of the radial head later on. It is important to view one joint above and below the fracture.

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Operative Treatment of Galeazzi Fracture – Tackling Distal Radioulnar Joint Instability

May 3, 2009 By Leave a Comment

As for treatment of fractures of both bones of Forearm, the implant of choice is limited contact dynamic compression plate and 3.5 mm screws.

Using dorsal or volar approach, the radius fragments are exposed and reduced. The fracture is fixed with implant of suitable size usually 6 or 7 hole plates but may be 5 holes in case one fragment is very small.

If fracture is transverse, the plate is applied in compression mode. However, in case of  comminution putting the plate in compression m0de would pull the radius from distal to fracture site. This could lead to disturbance of normal radius and ulna relation. This can cause malfunction of the wrist. Therefore,  in case of extensive comminution distally, the palte should be applied in neutralizing mode.

Assessment and Treatment of Distal Radioulnar Joint Stability

Clinically,  distal radioulnar joint stability is assessed by ballottement of the distal ulna relative to the distal radius. If  xray imaging is available, a radiological confirmation can be done peroperatively.

Most commonly, after fixation  of radius bone fracture distal radioulnar joint gets reduced and stable. Nothing more needs to be done in this situation. Wound is closed and a well padded dressing should  be done. Mobilization can be allowed as son as patient is able to do it.

If the joint is reducible but unstable, then the postiion of maximum stability should be found and limb should be splinted in that position. The splint is continued  for 4 weeks after the injury and the mobilization of the limb should begin. Night splinting in the stable position should continued until 3 months after injury. [Read more...]

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Isolated Fractures Of Radius Bone and Galleazi Fracture

May 2, 2009 By 1 Comment

Isolated fracture of the radius may occur as such or associated with injury to distal radio ulnar joint. This kind of fracture that is associated with injury to distal radio ulnar joint is called Galleazi Fracture.

A fracture of the similar pattern involving ulna and proximal radio ulnar joint is called Monteggia Fracture. Galeazzi fracture is three times more than Monteggia fracture.

Mechanism of injury

Galeazzi fracture usually occurs due to either direct blows on the dorsolateral side of the wrist or fall on the hand.

The most probable mechanism of injury in Galeazzi’s fracture is a fall on the outstretched hand combined with marked pronation of the forearm.

Clinical Presentation

the severity of the symptoms varies with severity of injury and the degree of displacement. [Read more...]

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Open Fractures of Forearm Bones – Diagnosis and Treatment

May 1, 2009 By Leave a Comment

Open fractures of forearm bones can occur in crush injuries of the limb, missile injuries and gun shot injuries. The diagnosis of an open fracture of the forearm is usually self-evident. There is history of bleeding or wound from the site of injury. In some cases there might be a spike of bone jutting out of the wound.

The limb must be examined to know the extent and severity of the injury. Small puncture wounds may have to be actively searched for if the active bleeding has stopped.  Presence of  wound increases the risk of infection and likelihood of insertion of foreign material.  A careful neural and vascular examination must be done as open injuries are most likely to cause neurovascular damage than closed fractures. [Read more...]

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