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Additionally, the chronic posterior subluxation and deformity of the radiocapitellar joint is a sequela from the Monteggia fracture-dislocation. The patient has a chronic proximal ulna malunion from a Monteggia fracture-dislocation.
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There are multiple pathologies present in this patient and numerous potential treatment options. Mild volar and dorsal muscle atrophy were present, which the patient stated were chronic at his baseline.Ĭhronic proximal ulna malunion with chronic posterior subluxation, deformity of radiocapitellar joint Radial, median and ulnar sensorimotor nerves were intact with normal ulnar and radial pulses at the wrist. Significant DRUJ instability was also appreciated. He had a 30° to 100° flexion-extension arc at the elbow. However, he had only a 10° flexion-extension arc of wrist ROM with mechanical block, as well as a mechanical block to pronosupination. There was a well-healed incision over the dorsal, proximal ulna. On exam, the patient had obvious deformity of the wrist with dorsal prominence of the ulnar head and associated tenderness at the ulnar wrist. AP (a), oblique (b) and lateral (c) left elbow X-rays demonstrating radiocapitellar subluxation with radial head deformity, proximal ulnar fracture malunion with intact hardware and mild ulno-trochlear post-traumatic arthritis are shown. Anteroposterior (AP) (a), oblique (b) and lateral (c) left wrist X-rays demonstrate dorsal DRUJ dislocation with significant ulnar impaction, and ulno- and radiocarpal arthritis are shown.Ģ. The patient currently denied elbow pain.ġ.
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There, radiographs of the left wrist and elbow were obtained demonstrating dorsal distal radioulnar joint (DRUJ) dislocation with significant ulnar impaction, ulnocarpal and radiocarpal arthritis, radiocapitellar subluxation with radial head deformity, and proximal ulnar fracture malunion with intact hardware (Figures 1 and 2). He had woken up from sleep with severe pain and was evaluated at an ED. The patient had 1 week of severe, atraumatic left wrist pain, dorsal deformity and decreased range of motion (ROM). If you continue to have this issue please contact to HealioĪ 39-year-old left-hand dominant man with a history of left Monteggia fracture-dislocation that was treated abroad about 10 years ago presented to clinic. It was elected to conclude the procedure at that point and to see how the patient rehabilitated.We were unable to process your request. At this point, it was simply unclear if this represented an old nursemaid's elbow with annular ligament interposed or some other distant injury because the range of motion appeared to be unrestricted. Interposed tissue was present between the radial head and the capitellum. As it was unclear what was preventing the reduction of the radial head, a radiocapitellar arthrotomy was made through a 3-cm longitudinal incision in the fascia centered over the radiocapitellar joint in line with the midaxis of the radius and supracondylar ridge of the distal humerus.
#Monteggia fracture full#
Passively at this point, the patient's elbow range of motion was full in both flexion and extension and in pronosupination. The ulna was then repaired, matching the contralateral anatomy (slight apex posterior bow), but the radial head remained subluxed anteriorly. On removal of the hardware, it was noted under intraoperative fluoroscopy that the radial head was resistant to reduction. The patient was taken back to the operating room 1 week after the initial procedure. American Society of Shoulder and Elbow Therapists.International Congress of Shoulder and Elbow Surgery.Shoulder and Elbow Society of Australia.South African Shoulder and Elbow Surgeons.European Society for Surgery of the Shoulder and Elbow.