![]() ![]() The goal of rehabilitation is the return of full range of motion and fine motor skills with the absence of pain. Rehabilitation usually begins at 2 weeks after surgical fixation. For Babo type 2 fractures the elbow should be splinted at 70-degrees.Īs with all fractures, the length of recovery depends on multiple variables including the severity of the injury, intended use of the extremity, and the individual’s ability to heal. After surgery, the extremity is placed in a long-arm splint with full supination and elbow flexion around 100-degrees for Babo types 1, 3, and 4 fractures. The radial head dislocation usually reduces easily after the ulna fracture is realigned. In most cases, a single compression plate is placed with approximately six cortical screws anchored proximally and distally. The most common operative repair is an ORIF. Adults are more prone to the persistent angulation and shortening despite closed reduction techniques. Operative management is crucial for the majority of adult Monteggia fractures. Comminuted or long oblique ulna fractures are fixed by ORIF using plates and screws. Short, oblique fractures should be stabilized with elastic intramedullary titanium nail fixation. Complete ulnar fractures will require operative management. This fracture should be treated with a closed reduction and splinted with the elbow flexed at approximately 110-degrees in full supination for 6 weeks. Non-operative management is successful in this population if the ulna has undergone a plastic deformation (bending or bowing without fracture) or an incomplete fracture (greenstick). Management is determined by the characteristics of the ulna fracture. This is thought to be due to multiple influences, including the remodeling ability of small angle deformities, shorter healing time, and overall solidity of Monteggia fractures in children. Patients with a Monteggia fracture should be placed in a sugar-tong splint with urgent referral to an orthopedist.Ĭhildren usually have better overall outcomes than adults. If the annular ligament is trapped within the joint, reduction may be unobtainable. In most circumstances, closed reduction should be attempted. Initial management for a suspected fracture includes rest, ice, immobilization, and elevation. Urgent orthopedic consultation is indicated for neurologic deficits without vascular compromise. Emergent orthopedic consultation is essential for open fractures and vascular compromise. Ulnar nerve injury is rare.Īll Monteggia fractures are considered unstable and require intervention. Although nerve injury is less common, examination of the radial and median nerve distribution is essential in identifying nerve damage. Inquire about numbness, weakness, paresthesias, and radiating pain. High mechanism crush injuries warrant a detailed neurovascular exam with repeat serial exams looking for signs of acute compartment syndrome. Examination of the proximal and distal joint should be performed to identify concomitant injuries. Gentle palpation should be performed identifying deformities and focal tenderness. It is imperative to identify wounds overlying fracture sites (i.e., open fracture), which requires immediate surgical intervention. An examination should begin with visual inspection paying close attention to the skin and soft tissue for visible bony deformities, muscle contusions, skin lacerations, tendon damage and neurovascular deficits. Patients with diaphyseal forearm fractures usually complain of pain at the site of injury. These types depend on the direction of the radial head dislocation. Jose Luis Babo classified Monteggia fractures into four types. The radiocapitellar joint primarily stabilizes the proximal forearm while the TFCC predominantly supports the distal forearm. The interosseous membrane is responsible for distributing axial load force to the forearm, 60% to the radiocapitellar joint and 40% to the ulnohumeral joint. The alignment and stability of the radius and ulna originate from three ligamentous structures: the interosseous membrane, the annular ligament, and the TFCC. ![]() Proximally, the ulna consists of the coronoid and olecranon. The ulnar head supplements the triangular fibrocartilage complex (TFCC) at the wrist. Distally, the radius connects with the scaphoid and lunate bones of the wrist. ![]() The proximal radial head articulates with the capitellum of the humerus (radiocapitellar joint), rotating within the annular ligament during pronation and supination. The osseous forearm is composed of the radius and ulna bones. ![]()
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |