6. PHYSICAL EXAMINATION
▸primary survey : A,B,C,D,E => pass
▸V/S : BT 37 C , BP 110/60 mmHg, PR 92/min, RR 16 /min
▸Effected part : left forearm deformity ,marked tender and
swelling at left proximal forearm , limit ROM of left elbow , no
external bleeding , intact neurovascular
14. MONTEGGIA FRACTURE
it is a fracture of proximal 3rd of the
ulnar with dislocation of radial head
15. EPIDERMIOLOGY
Rare in adults
more common in children with peak incidence between in
4 and 10 years of age
Prognosis
if diagnosis is delayed greater than 2-3 weeks complication
rates increase significantly
23. TREATMENT
(A). NONOPERATIVE
-CLOSED REDUCTION OF ULNA AND RADIAL HEAD
DISLOCATION AND LONG ARM CASTING
INDICATIONS
BADO TYPES I-III WITH
-RADIAL HEAD IS STABLE FOLLOWING
REDUCTION
-LENGTH STABLE ULNAR FRACTURE PATTERN
REDUCTION TECHNIQUE
-REDUCTION TECHNIQUE USES TRACTION
RADIAL HEAD WILL REDUCE SPONTANEOUSLY
WITH REDUCTION OF THE ULNA AND
RESTORATION OF ULNAR LENGTH
IMMOBILIZATION
- IMMOBILIZE IN 110° OF FLEXION AND FULL
SUPINATION FOR TYPES I AND III TO TIGHTEN
INTEROSSEOUS MEMBRANE AND RELAX
BICEPS TENDON
26. TREATMENT
(B)OPERATIVE
1) FLEXIBLE IM NAILING OR PLATING OF ULNA WITH REDUCTION OF
RADIAL HEAD
INDICATIONS
-BADO TYPES I-III WITH
-RADIAL HEAD IS NOT STABLE FOLLOWING
REDUCTION
-ULNAR LENGTH IS NOT STABLE (UNABLE TO
MAINTAIN ULNAR LENGTH)
-ACUTE BADO TYPE IV
-OPEN FRACTURES
2) ULNAR OSTEOTOMY AND ANNULAR LIGAMENT RECONSTRUCTION
INDICATIONS
-CHRONIC (>2-3 WEEKS OLD) MONTEGGIA FRACTURES
-SYMPTOMATIC INDIVIDUALS (PAIN, LOSS OF FOREARM
MOTION, PROGRESSIVE VALGUS DEFORMITY)
-WHO HAD DELAYED TREATMENT OR MISSED DIAGNOSIS
3)ORIF SIMILAR TO ADULT TREATMENT
INDICATIONS
-CLOSED PHYSES
27. COMPLICATION
1) NEUROVASCULAR
-POSTERIOR INTEROSSEOUS NERVE NEURAPRAXIA (10%
OF ACUTE INJURIES)
=>ALMOST ALWAYS SPONTANEOUSLY RESOLVES
2) DELAYED OR MISSED DIAGNOSIS
-COMMON WHEN EVALUATION NOT PERFORMED BY AN
ORTHOPAEDIC SURGEON
-COMPLICATION RATES AND SEVERITY INCREASE IF
DIAGNOSIS DELAYED >2-3 WEEKS
