вверх
отправить
поиск
админ
главная
|
 Отправлено V. M. Iyer 06 Декабрь 2004, 23:34
Dear All, Another case being put up on behalf of my colleague20 yrs old active male. RTA 7 weeks ago. Closed # both bones forearm with anterior dislocation of the radial head, closed # midshaft humerus same side, crush injury left lower limb beyond salvage.
At the place of first management, the radius and ulna were fixed intramedullary by closed method, some reduction of the radial head achieved and an attempt made to keep the radial head in position. BK amputation was done. Three days later, he shifted to another hospital where the humerus was fixed with a locked nail and findind the radial head remaining dispalced anteriorly an attempt was made to reduce the radial head closed.(without success). Now the patient has the radial head still displaced anteriorly. There is no radial palsy. My suggestion was as follows:The reason for the head not getting reduced is at least partially due the length of ulna not having been restored.ExFix of any type in the ulna, distract till the legth is restored and try to reduce by flexing the elbow to extreme flexion. If necessary open reduction of the radial head and retain with a sling made of fascia lata.Your comments are welcome. RegardsV M Iyer. Iyer Orthopaedic Centre, 103,Railway lines Solapur India
<
|
>
|
|
Ответить
|
Re: Monteggia fracture
Виктор П. Волошин 07 Декабрь 2004, 01:04
|
That'll go
|
[
Ответить ]
|
Re: Monteggia fracture
Alexander Chelnokov 07 Декабрь 2004, 01:13
|
VMI> The reason for the head not getting reduced is at least
VMI> partially due the length of ulna not having been restored.
Not likely to my view. The problem goes from 1)the annular ligament rupture and 2)the wires missed the radial head - they are not even bent while the head is out of its position after the "fixation".
VMI> ExFix of any type in the ulna, distract till the legth is
VMI> restored and try to reduce by flexing the elbow to extreme
There is a well established Ilizarov technique for forearm fractures and particularly the Monteggia conponent - after closed reduction the proximal radius is fixed by an olive wire, it is a single wire through the both bones.
forearm.gif
7KB (7640 bytes)
|
[
Ответить ]
|
Re: Monteggia fracture
Отправитель: George Tomas 07 Декабрь 2004, 19:14
|
I agree with Dr. Iyer that the problem is due chiefly to the length of the ulna not being restored. This is probably because the large butterfly fragment has caused the bone to collapse enough to prevent the radial head being reduced. I would do an open reduction of the ulna with bridge plate osteosynthesis after checking with image intensifier that the radial head is reduced. Only if the head still remains dislocated would I do an open reduction and annular ligament reconstruction. The radial fracture also I would plate.
|
[
Ответить ]
|
Re: Monteggia fracture
Отправитель: Andrey 09 Декабрь 2004, 01:33
|
It seems to me, that first of all you would better to remove all the pins from the forearm, and then,
ulna`s fragments must be fixed by 1\3 tub. bridge-plate with restoring bone`s length, and you will be able to reduce the head of radius by Boid`s procedure. The distal part of radius may be fixed by plate.
Kind regards, Andrey.
|
[
Ответить ]
|
|
( Ответить )
|
|
Monteggia fracture
