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.