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Re: Monteggia fracture
Alexander Chelnokov 07 Декабрь 2004, 01:13
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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.
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Re: Monteggia fracture
George Tomas 07 Декабрь 2004, 19:14
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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.
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Re: Monteggia fracture
Отправитель: Andrey 09 Декабрь 2004, 01:33
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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.
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