Both operative and non operative treatment methods are described and are equally successful. The injury pattern is easily missed initially or later if not followed up adequately. The use of homoplastic cortical bone graft represents an effective technique to improve the mechanical properties of the fixation and supports biological union, even when the bone defect is severe. Monteggia fracture patterns are rare in children and merits appropriate treatment to avoid late disability of the elbow and forearm. The score, according to the Broberg-Morrey scoring system, was 78 in group A patients and 93 in group B patients. The patient healed after a new surgery performed with same technique. Complications included a case of nonunion due to failure of the intercalary graft with plate breakage. Clinical-radiographic healing was achieved in all patients followed for a mean of 27 months. In 3 patients (group A), where the defect was smaller than 1 cm, fixation of the ulna was combined with a resection of the radial neck. In all cases, after fibrous callus debridement and bone surface remodelling, fixation was performed with plate and screws and homoplastic cortical bone graft (orthogonal or parallel to the plate) and an intercalary bone cylinder when the bone defect was severe. If not diagnosed at an early stage, these lesions can gradually lead to forearm deformities and dysfunction, finally resulting in neglected Monteggia fracture. According to the type of primary injury and its anatomical site, the nonunions were classified into 2 groups, considering that the nonunions nearest to the humerus-ulna joint present a more disabling clinical profile and are more difficult to treat: group A (6 patients - nonunion within 5 cm from the olecranon tip of the olecranon) and group B (6 patients - nonunion between 5 and 10 cm from the olecranon tip of the olecranon). Monteggia fracture is characterized by radial head dislocation combined with proximal ulnar fracture. The Jupiter classification captures this injury pattern as a subgroup of Bado posterior Monteggia lesions. The presence of radial head/neck fracture and comminution of the proximal ulna with coronoid involvement elevates the complexity of surgical reconstruction considerably. The primary injuries were 2 fracture-dislocations of the olecranon, 6 Monteggia lesions and 3 isolated fractures of the proximal ulna. Monteggia fractures classically involve a proximal ulna fracture with an associated radial head dislocation. We reviewed our experience in the surgical treatment of 12 cases of proximal ulna nonunion.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |