![]() Monteggia fractures are mainly associated with falls on an outstretched hand with forced pronation. According to this subclassification: type IIa, an ulna fracture involving the distal end of the olecranon and the coronoid process type IIb, a metaphyseal-diaphyseal fracture, distal to the coronoid process type llc, a diaphyseal fracture of the ulna and type IId, a fracture of the ulna halfway through the bone. Additionally, Jupiter in 1991 subclassified the type II lesions. Later, Bado in 1967 used the term “Monteggia lesions” to classify these injuries into four types: type I, fracture of the proximal or middle third of the ulna with anterior dislocation of the radial head type II, fracture of the proximal or middle third of the ulna with posterior dislocation of the radial head type III, fracture of the ulnar metaphysis (distal to coronoid process) with lateral dislocation of the radial head and type IV, fracture of the proximal or middle third of the ulna and radius with dislocation of the radial head in any direction. The Monteggia injury was first described in 1814 by Giovanni Battista Monteggia as “radial head dislocation with ulnar fracture, located between the proximal third and base of the olecranon.” Monteggia based his findings exclusively on clinical examination and injury mechanism, since no X-rays were available at the time. Anatomical restoration is very important to function therefore, any forearm shaft fracture is considered equivalent to an articular fracture. Hence, the forearm bones are considered a single functional unit. The radial bow and the relationship between the proximal and distal radioulnar joints comprise a complex three-dimensional unit. Although the patient is right-handed, he continues to work as a painter without significant problems in his everyday routine (DASH-work module = 6.3), and he is still regularly engaged in cycling (DASH-Sports/Performing Arts Module Score = 18.8). Radial and ulnar deviation of both wrists was 25-0-35. The extension–flexion of the right wrist was 70-0-50 compared to 80-0-60 of that of the opposite side. 4) The 5-degree deficit in elbow extension, as well as the 15-degree in hand pronation and the 20-degree one in supination remained. X-rays and CT showed sufficient callus formation (Fig. After surgery, his forearm was immobilized in a posterior, above elbow cast in neutral rotation for another 4 weeks.Īt the 12-month follow-up, the patient had Disabilities of the Arm, Shoulder and Hand (DASH) score of 10. The patient underwent at that point surgery with autologous bone grafting from the iliac crest. X-rays and Computed Tomography (CT) did not show callus formation in neither the ulnar nor the radial shaft fracture therefore, the diagnosis of atrophic pseudarthrosis was established. At the 6-month follow-up, the patient still had a 5° extension deficit in the right elbow and a 15° deficit in pronation, as well as a 20° deficit in supination in the right hand. No load bearing was allowed until callus formation.Īt the 4-month follow-up, the patient had active extension/flexion in the right elbow 0-5-135°, compared to 0-0-135 of the left side, while pronation/supination of the right hand was 65-0-70°, compared to 80-0-90 of the opposite healthy extremity. The patient performed active movements, without any limits in range of motion (flexion and extension of the elbow, as well as supination and pronation). ![]() After cast removal, the patient was subjected to physiotherapy. After 1 month, the Kirschner wire in the distal radioulnar joint was removed. He made a satisfactory recovery and was discharged on the 11th postoperative day. The patient received parenteral antibiotic treatment, with 1.5 g of cefuroxime per 8 h, during his hospitalization, as well as one dose at the emergency department and one while on the operating table.
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