Forearm,Montegia&Galleazzi Fractures Dislocations

Report
‫دکتر اکبری اقدم‬
‫استادیار دانشکده پزشکی اصفهان‬
Common 12 to 16y
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Most common site for refracture
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Fx suspected >>child has not returned all
normal arm function within 1 to 2 days of
injury
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Practical classification 
2 bones
3 levels
4fracture patterns
(Bow,Greenstick,Compelet&Comminuted)
Closed Reduction still remains the gold
standard for closed isolated pediatric forearm
fractures
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Non or minimally displace 
Long arm cast(except above 4 y with stable
distal third fx)
1 and 2 week visit
6-8 week cast
After that splint until union compelet
Displaced fractures 
Manipolation with sedation
Contorol with fluroscopy
Sugar tong splint(7-10 layers 3inch plaster)
Next week x-ray and change splint to cast
2 next weeks follow up
4 weeks after reduction can chang short cast
Except under 4 y
Return to sport now if…
Distal third< 20 degree 
Middle third< 15 degree 
Upper third <10 degree 
100% translation with <1cm shortening 
Rotation< 45 degree.difficult to measure 
Bicipital tuberisity and radial styloid
Open fracture
Fracture with unacceptibale reduction
Fx in assosiated supracodylar fx(to avoid risk
of compartement syn)
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Interamedullary fixation is preferred 
If one bone fixation Fix ulna
If both bone should be fix,radius first
2-2.5 mm nail
brace or cast
6-12 mo nail removal
Redisplacement
Forearm stiffness
Refracture
Malunion
Nonunion
Cross union(synostosis)
Infection
…
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Type 1
Ant dis radial head associated with ulnar
diaphyseal fx at any level(most common)
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Ant radial head dislocasion 
(include pulled elbow)
No plastic deformity of ulna
Ant dis radial head with radial neck fx 
Ant dis radial head with fx of radial 
diaphyseal fx proximal to ulnar fx
…. 
direct blow theory
Hyperpronation theory
Hyperextention theory
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Fusiform swelling elbow
Pain &limit ROM elbow
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Three steps:
Correcting the ulnar deformity
Stable reduction of radial head
Maintaining ulnar length and fx stability
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A bivalved long arm cast 4-6 w slight
supination and elbow 90 to 110 flex
Radiography every 1 to 2 w
Hardware remove
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Congenital 
Posterior
Bilateral
Can be associated with various syndromes
Traumatic 
Isolated ant. Or ant lateral dislocation
Unless congenital or systemic difference
Posterior monteggia fx dx 
Rare in children usully older patient 
Mechanism 
Direct force,sudden rotation and supination
Suddenly loaded in longitodinal direction elbow
at 60 flex
Incomplete fx ulna>>close reduction casting
in extension
If doubt>>interamedullary fixation
Comminuted or very proximal ulnar
fx>>open reduction plate screw
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Lat swelling,varus,significant limitation of
ROM
Mechanism>>hyperextesion of elbow
combined with pronation
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Incomplete or plastic deformation of ulna 
Close reduction >>
Elbow in extension longitudinal traction valgus
sterss test
Long arm cast elbow 70 to 80 flex
Ant dis with fx both radius and ulna 
Radial fx level same or distal too ulnar fx
Fx unstable 
fixation
Chronic Monteggia Injury
Under 12 years old
MRI
Determine congruency radial head and
capitellum
Surgery 
Radial nerve identify
Anconeous-extansor carpiulnaris interval
Repair or reconsteraction of annular lig
Radius head unreduceable >>ulnar osteotomy
After radial head redauction>>anullar lig repi
Fracture of the distal radius with DRUJ
disruption
Mechanism >>axial load ,forearm rotation
Signs &symptoms>>pain,limitation of
forearm rotation,wrist flex ext
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Type 1 dorsal (apex volar)displacment 
Type 2 volar(apex dorsal)displacment 
Galeazzi equivalent 
Distal radius fx with distal ulnar physis
disruption
Volar apex 
Radius fx greenstick or incomplete
Close reduction and long arm cast in
supination
Complete fx
Open reduction and fix with plate
Incompelet radius fx 
Close reduction
Compelet fx 
Open reduction

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