Transcript MONTEGGIA AND GALEAZZI FRACTURES

MONTEGGIA AND
GALEAZZI FRACTURES
ANATOMY-ELBOW
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Hinge joint.
Three bones form the elbow joint: the humerus
of the upper arm, and the paired radius and
ulna of the forearm.
The bony prominence at the very tip of the
elbow is the olecranon process of the ulna, and
the inner aspect of the elbow is called the
antecubital fossa.
Humeroulnar joint**from trochlear notch of the ulna
**to trochlea of humerus
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Is a simple hinge-joint, and allows of
movements of flexion and extension only.
Humeroradial joint**from head of the radius
**to capitulum of the humerus
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Is a hinge-joint
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Proximal radioulnar joint.
**From-head of the radius
**to radial notch of the ulna
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pronation and supination.
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Ligaments:Ulnar collateral ligament,
Radial collateral ligament, and
Annular ligament.
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The muscles in relation with the joint are:
in front, the Brachialis, the Brachioradialis
behind, the Triceps brachii and Anconæus
laterally, the Supinator,
and the common tendon of origin of the Extensor
muscles
medially, -common tendon of origin of the Flexor
muscles,
and the Flexor carpi ulnaris
Movements
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The hinge-like bending and straightening
(flexion and extension) between the humerus
and the ulna.
The complex action of turning the forearm
over (pronation or supination) happens at the
articulation between the radius and the ulna
(this movement also occurs at the wrist joint).
The hinge moves in only one plane.
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The Arteries supplying the joint are derived from the
anastomosis between the profunda and the superior
and inferior ulnar collateral branches of the brachial,
with the anterior, posterior, and interosseous recurrent
branches of the ulnar, and the recurrent branch of the
radial. These vessels form a complete anastomotic
network around the joint.
The Nerves of the joint are a twig from the ulnar, as it
passes between the medial condyle and the olecranon;
a filament from the musculocutaneous, and two from
the median.
Monteggia fracture
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# of upper third of ulna with dislocation of
head of radius.
Head of radius is dislocated both from the
radioulnar articulation and from elbow joint.
It may be displaced –Ant,post,or laterally acc
to angulature of ulnar fracture.
DIAGNOSIS
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Every # of upper shaft of ulna without # of
radial shaft should be considered to be
monteggia # unless otherwise proved.
first X ray may show head of radius in its
correct position, but serial X rays have to be
taken over 1st few weeks –bcoz if dislocation
has occurred and there is instability ,head of
radius may redisplace later.
Displacement-3 types
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Monteggia # dislocations can take place from
3 forces and corresponding injuries seen.
FLEXION INJURY
EXTENSION INJURY
ADDUCTION INJURY
***Hume fracture
FLEXION INJURY-10-15%
 # ulna is angulated
with the convexity
posteriorly and the
head of radius is
dislocated
backwards.
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EXTENSION INJURY-85-90%
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Commonest type.
# ulna is angulated with covexity ant. and
laterally.
With head of radius dislocated forwards and
laterally.
Adduction injury
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Caused by adduction strain at the elbow.
Ulna is angulated laterally and radial head is
displaced laterally.
HUME FRACTURE
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“High Monteggia injury”.
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1957 Hume described --fracture of the
olecranon with an associated anterior
dislocation of the radial head .
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Seen in Children.
MECHANISM OF INJURY.
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Mervyn Evans suggested this mech.
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1**Fall on outstretched hand with twisting of
the trunk,forcibly pronating the forearm.
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2**Direct injury-Africa-Direct blow on the
back of forearm with a stickwhile arm is raised
warding off an attacker.
TREATMENT
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CONSERVATIVE
OPERATIVE
CONSERVATIVE:
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Children.
manipulation and plaster immobilisation.
But close watch needed-recurrence of
deformity.
Redn. of extension injury.
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Longitudinal traction of forearm with with the
elbow flexed as much as possible without
compromising the blood supply.
Forearm is stable in supination
Plaster windowed for radial pulse
Redn of adduction injury.
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Traction of the forearm with elbow extended
and pressure over the head of radius, and after
redn.this # dislocation is stable with the elbow
flexed.and with forearm supinated.
Redn of flexion injury
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Traction on forearm with elbow extende and as
the redn is stable only in the extended position
–not advisable in adults.
OPERATIVE TREATMENT.
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Advisable in adults.
Open redn of # ulna and rigid int. fixation
preferable with a plate..
Dislocation of head of radius red.
spontaneously when the deformity of ulna has
been reduced.
OPERATIVE TECHNIQUE.
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# of ulna is exposed ,reduced and fixed by a
compression plate,or IM nail.
Intraop take xray elbow in 2 planes.
If head of radius is perfectly reduced, the
position is accepted and well padded plaster
cast is applied from metacarpals to axilla- with
elbow at right angles and forearm supinated.
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If X ray shows –head of radius is not reduced,
then it must be exposed and reduced under
direct vision.
Annular lig. --usually cause obstructionincised.
COMPLICATIONS
1.UNREDUCED DISLOCATION OF HEAD
OF RADIUS.
2.TRAUMATIC OSSIFICATION AROUND
RADIAL HEAD.
3.PIN PALSY
4.CROSS UNION B/W RADIUS AND ULNA.
5.DISLOCATION OF LOWER END OF ULNA
6.UN-UNITED # OF ULNA.
Unred. disl. of head of radius.
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Rx
Excision of displaced head of radius.
Prod inc. elbow flexion and good range of
pronation and supination.
NOT done in CHILDREN.—removal of upper
radial epiphysis—inequality of length of
forearm bones and cause further disl. of RU
joints both sup. and inf.
Traumatic ossi. around radial head.
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Excision of radial head and the block of bone
attached to it.
Recurrence.
Can be reduced by Sx delayed 6-12 months
after injury with elbow immobilised for atleast
2 weeks.
NO Physiotherapy,manipulation and passive
excs during rehab period.
PIN PALSY
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Common with Adduction # dislocation.
Prognosis good in early complete reduction of
head of radius.
Late PIN palsy due to inadequate redn of radial
head.
Cross union b/w radius and ulna.
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Bony fusion b/w neck of radius and 3 site of
upper 3rd of ulna.
Difficult to Rx.
B coz proximity of elbow jt and PIN.
***Recurrence is high.
***Perm limitation of Radioulnar movt.
Dislocation of lower end of ulna
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REDUCES with redn of ulnar shaft #.
WORSENS if head of radius is excised.
Rx excise distal inch of ulnar-if wrist
symptoms.
Un united # of ulna
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Notorious for that.
Rigid internal fixation and cancellous onlay
grafting.
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