Open reduction of Monteja fractures

Montejaja fracture open reduction is used for the treatment of Monteggia fractures. The Monteggia fracture was first reported by Giovanni B. Monteggia in 1814. In 1950, Jose Luis Bado divided it into four types according to the injury mechanism of the Monteggia fracture, namely, type 1: anterior dislocation of the humerus and ulnar shaft fracture, which accounted for 70% of children's Monteggia fractures. Type 2: posterior dislocation of the humerus with the ulnar shaft or proximal metaphyseal fracture of the ulna, and the fracture is angulated backward. This type is not common in children. Type III: The lateral head of the humerus is dislocated to the lateral or anterior lateral side, with a proximal metaphyseal fracture of the ulna. This type accounts for 23% of the Monteggia fracture of the child. This type often has a radial nerve injury. Type 4: rare in children, dislocation of the humeral head, accompanied by ulnar and mid-humeral fractures, ulnar fractures can be in the same plane as the humeral fracture, or closer to the proximal end. In addition, there are four similar fracture types. The above classification is still in use today. Most of the children's Monteggia fractures can be closed and reset. The main points of closure and reduction are: 1Reset the ulnar fracture, restore the length of the ulna by traction, correct the angular deformity by manipulation, and maintain the forearm supination position. 2 Secondly, the humeral head is reset, usually only 90° above the elbow joint can be reset. If necessary, the humeral head can be pressed backwards to facilitate the reduction. 3 Relieve the tension that causes malformation: flexion elbow joint 110 ° ~ 120 ° to relieve the biceps muscle tension that can cause the humeral head to dislocate. The forearm is maintained in a moderate supination to neutral position to relieve tension in the supinator, elbow and forearm flexors that can cause the ulnar to be angled to the temporal side. 4 fixation: maintain the elbow joint 110 ° ~ 120 °, the forearm moderate rotation to the neutral position, the upper limb plaster is fixed for 3 to 4 weeks, and then the forearm tubular plaster is replaced for 3 to 4 weeks. Treatment of diseases: Monteggia fracture Indication 1. The ulnar reduction failed. 2. The humeral head failed to reset. Preoperative preparation Regular preoperative examination. Surgical procedure Incision The posterior lateral incision of the elbow was used, which was 2 cm above the superior iliac crest and extended to the posterior aspect of the elbow joint. It stopped at the posterolateral aspect of the upper 1/3 of the ulna and was about 10 cm long. 2. Reveal the upper ankle joint The skin and subcutaneous tissue were dissected, the deep fascia was dissected, and the gap between the elbow muscle and the ulnar wrist muscle was separated, and the humeral humeral head joint capsule was exposed and longitudinally cut to reveal the upper ankle joint. 3. Repair the annular ligament After exposing the upper ankle joint, carefully explore the factors affecting the reduction, and take the corresponding repair method according to the damage of the annular ligament. If the annular ligament is not broken, the annular ligament can be inserted into the humeral neck. When the annular ligament is embedded in the joint space and the adhesion is obvious, the adhesion is separated, the annular ligament is cut open, the humeral head is reset, and the suture is repeated. ligament. For patients who are still unstable or more than 12 years old after the reduction of the upper 1/3 of the ulna, a single thick Kirschner wire can be used for internal fixation or a four-hole plate for internal fixation. Relax the tourniquet, stop the bleeding completely, and suture the incision layer by layer.