Monteggia Fracture Dislocation
Classification
Bado - Anterior - 75 - 80 %
Posterior - 5 % , common in adults
Lateral - 15-25 %
Any type associated with radial shaft. fracture , rare.
https://rayorthos.com/bado-classification-of-monteggia-fractures/
Management
ATLS review
Full history
Examination - r/o other injuries , open wounds, compartment syndrome, DNVS
Further radigraphs
Urgent reduction and fixation
Direct approach to ulna
Internervous plane - ; ECU (PIN) and FCU (UN)
Fixation using 3.5 mm DCP using AO principle
How does DCP work ?
It words in different modes.
Compression - Placing screws eccentrically in combihole to allow sliding compression at fracture site ( simple unstable two piece fractures )
Neutralization - provides interfragmentary compression achieved by lag screw fixation as in fracture with a butterfly fragment .
Buttress or Briding Plate - prevents fracture collapse in non-reducible communited fractures )
Post operatively - protect soft tissues in backslab for four weeks to prevent lateral subluxation of radial head.
Physiotherapy to regain elbow ROM.
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