Adult Monteggia Fracture/Dislocation

Lee Hunter MD, MBA

Hunter Medical Founder and Chief Medical Officer

February 2018

 

Monteggia variant fracture dislocations in adults generally require surgical treatment and can be challenging cases. Malunion, non-union, and persistent elbow instability are well-recognized complications. Supine patient positioning is ideal for these injuries, allowing the surgeon circumferential access to the elbow joint if necessary, as well as ease of intraoperative elbow joint and forearm manipulation.

82 YO Female With Monteggia Variant Fracture/Subluxation

The patient fell and sustained a comminuted proximal ulna fracture involving the metaphysis at the level of the coronoid process as well as a radial neck fracture. Both fractures were displaced with a flexion moment and thus required surgical intervention.

The Procedure

   The patient was positioned supine utilizing the ElbowLOC® Arm Positioning System. A standard posterior approach was made. The ulna fracture was exposed first. The bulk of the lateral collateral ligament fortunately remained attached to a large butterfly fragment of the ulna containing the supinator crest and was preserved. This large bone fragment was retracted, and a longitudinal split made in the posterolateral capsule to expose the lateral aspect of the joint. The radial head was floating freely, and was removed. A press fit radial head implant was inserted and reduced. Next the Reducer/Distractor component of the ElbowLOC was attached to the Supine Positioner to grossly reduce and stabilize the ulna fracture and keep it from sagging into extension. The ulna fracture reduction was then easily finalized and held with bone clamps while an extended olecranon plate along with interfragmentary screws applied.

The Reducer/Distractor component of the ElbowLOC easily maintains gross fracture reduction and length. Thus the surgeon can focus on “fine tuning” the reduction and applying the fixation, while not having to constantly fight to maintain the gross fracture length and alignment.

This case is another great example of how the ElbowLOC® simplifies and accelerates procedural times for many elbow surgeries and makes surgery easier for the surgeon, patient, and staff!

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