dr mangala rajeevlklk-2

7/23/2019 Dr Mangala Rajeevlklk-2

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MONTEGGIA ANDMONTEGGIA AND

GALEAZZI FRACTURESGALEAZZI FRACTURES


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ANATOMY-ELBOWANATOMY-ELBOW

Hinge joint.Hinge joint.

Three bones form the elbow joint: theThree bones form the elbow joint: the humerushumerus

of the upper arm, and the pairedof the upper arm, and the paired radiusradiusandandulnaulnaof the forearm.of the forearm.

The bony prominence at the very tip of theThe bony prominence at the very tip of the

elbow is theelbow is the olecranonolecranonprocess of the ulna, andprocess of the ulna, and

the inner aspect of the elbow is called thethe inner aspect of the elbow is called the

antecubital fossaantecubital fossa..
http://en.wikipedia.org/wiki/Humerushttp://en.wikipedia.org/wiki/Humerushttp://en.wikipedia.org/wiki/Radius_(bone)http://en.wikipedia.org/wiki/Radius_(bone)http://en.wikipedia.org/wiki/Ulnahttp://en.wikipedia.org/wiki/Ulnahttp://en.wikipedia.org/wiki/Olecranonhttp://en.wikipedia.org/wiki/Olecranonhttp://en.wikipedia.org/wiki/Antecubital_fossahttp://en.wikipedia.org/wiki/Antecubital_fossahttp://en.wikipedia.org/wiki/Antecubital_fossahttp://en.wikipedia.org/wiki/Olecranonhttp://en.wikipedia.org/wiki/Ulnahttp://en.wikipedia.org/wiki/Radius_(bone)http://en.wikipedia.org/wiki/Humerus


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HHumeroulnarumeroulnarjointjoint--

**from t**from trochlearrochlearnotchnotchof theof the ulnaulna

**to**to trochleatrochleaofof humerushumerus

Is a simpleIs a simple hinge-jointhinge-joint, and allows of, and allows of

movements of fleion and etension only.movements of fleion and etension only.
http://en.wikipedia.org/wiki/Humeroulnar_jointhttp://en.wikipedia.org/wiki/Humeroulnar_jointhttp://en.wikipedia.org/wiki/Humeroulnar_jointhttp://en.wikipedia.org/wiki/Humeroulnar_jointhttp://en.wikipedia.org/wiki/Trochlear_notchhttp://en.wikipedia.org/wiki/Trochlear_notchhttp://en.wikipedia.org/wiki/Trochlear_notchhttp://en.wikipedia.org/wiki/Trochlear_notchhttp://en.wikipedia.org/wiki/Ulnahttp://en.wikipedia.org/wiki/Ulnahttp://en.wikipedia.org/wiki/Trochlea_of_humerushttp://en.wikipedia.org/wiki/Trochlea_of_humerushttp://en.wikipedia.org/wiki/Trochlea_of_humerushttp://en.wikipedia.org/wiki/Trochlea_of_humerushttp://en.wikipedia.org/wiki/Trochlea_of_humerushttp://en.wikipedia.org/wiki/Trochlea_of_humerushttp://en.wikipedia.org/wiki/Hinge-jointhttp://en.wikipedia.org/wiki/Hinge-jointhttp://en.wikipedia.org/wiki/Hinge-jointhttp://en.wikipedia.org/wiki/Trochlea_of_humerushttp://en.wikipedia.org/wiki/Trochlea_of_humerushttp://en.wikipedia.org/wiki/Trochlea_of_humerushttp://en.wikipedia.org/wiki/Ulnahttp://en.wikipedia.org/wiki/Trochlear_notchhttp://en.wikipedia.org/wiki/Trochlear_notchhttp://en.wikipedia.org/wiki/Humeroulnar_jointhttp://en.wikipedia.org/wiki/Humeroulnar_joint


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HHumeroradialumeroradialjointjoint--

**from**from head of the radiushead of the radius

**to**to capitulumcapitulumof theof thehumerushumerus

Is aIs a hinge-jointhinge-joint
http://en.wikipedia.org/wiki/Humeroradial_jointhttp://en.wikipedia.org/wiki/Humeroradial_jointhttp://en.wikipedia.org/wiki/Humeroradial_jointhttp://en.wikipedia.org/wiki/Humeroradial_jointhttp://en.wikipedia.org/wiki/Head_of_the_radiushttp://en.wikipedia.org/wiki/Head_of_the_radiushttp://en.wikipedia.org/wiki/Capitulum_of_the_humerushttp://en.wikipedia.org/wiki/Capitulum_of_the_humerushttp://en.wikipedia.org/wiki/Capitulum_of_the_humerushttp://en.wikipedia.org/wiki/Capitulum_of_the_humerushttp://en.wikipedia.org/wiki/Capitulum_of_the_humerushttp://en.wikipedia.org/wiki/Capitulum_of_the_humerushttp://en.wikipedia.org/wiki/Hinge-jointhttp://en.wikipedia.org/wiki/Hinge-jointhttp://en.wikipedia.org/wiki/Hinge-jointhttp://en.wikipedia.org/wiki/Capitulum_of_the_humerushttp://en.wikipedia.org/wiki/Capitulum_of_the_humerushttp://en.wikipedia.org/wiki/Capitulum_of_the_humerushttp://en.wikipedia.org/wiki/Head_of_the_radiushttp://en.wikipedia.org/wiki/Humeroradial_jointhttp://en.wikipedia.org/wiki/Humeroradial_joint


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!!roimalroimalradioulnarradioulnarjointjoint..

**"rom-**"rom-head of the radiushead of the radius**to**to radial notchradial notchof theof the ulnaulna

pronationpronationandand supinationsupination..
http://en.wikipedia.org/wiki/Proximal_radioulnar_jointhttp://en.wikipedia.org/wiki/Proximal_radioulnar_jointhttp://en.wikipedia.org/wiki/Proximal_radioulnar_jointhttp://en.wikipedia.org/wiki/Proximal_radioulnar_jointhttp://en.wikipedia.org/wiki/Proximal_radioulnar_jointhttp://en.wikipedia.org/wiki/Proximal_radioulnar_jointhttp://en.wikipedia.org/wiki/Head_of_the_radiushttp://en.wikipedia.org/wiki/Head_of_the_radiushttp://en.wikipedia.org/wiki/Radial_notchhttp://en.wikipedia.org/wiki/Radial_notchhttp://en.wikipedia.org/wiki/Ulnahttp://en.wikipedia.org/wiki/Ulnahttp://en.wikipedia.org/wiki/Pronationhttp://en.wikipedia.org/wiki/Pronationhttp://en.wikipedia.org/wiki/Supinationhttp://en.wikipedia.org/wiki/Supinationhttp://en.wikipedia.org/wiki/Supinationhttp://en.wikipedia.org/wiki/Pronationhttp://en.wikipedia.org/wiki/Ulnahttp://en.wikipedia.org/wiki/Radial_notchhttp://en.wikipedia.org/wiki/Head_of_the_radiushttp://en.wikipedia.org/wiki/Proximal_radioulnar_jointhttp://en.wikipedia.org/wiki/Proximal_radioulnar_jointhttp://en.wikipedia.org/wiki/Proximal_radioulnar_joint


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#igaments:-#igaments:-

$$lnar collateral ligamentlnar collateral ligament,,

%%adial collateral ligamentadial collateral ligament, and, and &&nnular ligamentnnular ligament..
http://en.wikipedia.org/wiki/Ulnar_collateral_ligament_(elbow)http://en.wikipedia.org/wiki/Ulnar_collateral_ligament_(elbow)http://en.wikipedia.org/wiki/Radial_collateral_ligament_(elbow)http://en.wikipedia.org/wiki/Radial_collateral_ligament_(elbow)http://en.wikipedia.org/wiki/Annular_ligamenthttp://en.wikipedia.org/wiki/Annular_ligamenthttp://en.wikipedia.org/wiki/Annular_ligamenthttp://en.wikipedia.org/wiki/Radial_collateral_ligament_(elbow)http://en.wikipedia.org/wiki/Ulnar_collateral_ligament_(elbow)


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TheThe musclesmusclesin relation with the joint are:in relation with the joint are:

in front,the 'rachialis, the 'rachioradialis

behind,the Tricepsbrachiiand &ncon(us

laterally,the )upinator,and the common tendon of origin of the tensor

muscles

medially,-common tendon of origin of the "leor

muscles,

and the "leorcarpiulnaris
http://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Brachialis_musclehttp://en.wikipedia.org/wiki/Brachioradialishttp://en.wikipedia.org/wiki/Triceps_brachii_musclehttp://en.wikipedia.org/wiki/Triceps_brachii_musclehttp://en.wikipedia.org/wiki/Ancon%C3%A6us_musclehttp://en.wikipedia.org/wiki/Supinator_musclehttp://en.wikipedia.org/wiki/Flexor_carpi_ulnaris_musclehttp://en.wikipedia.org/wiki/Flexor_carpi_ulnaris_musclehttp://en.wikipedia.org/wiki/Flexor_carpi_ulnaris_musclehttp://en.wikipedia.org/wiki/Flexor_carpi_ulnaris_musclehttp://en.wikipedia.org/wiki/Flexor_carpi_ulnaris_musclehttp://en.wikipedia.org/wiki/Flexor_carpi_ulnaris_musclehttp://en.wikipedia.org/wiki/Supinator_musclehttp://en.wikipedia.org/wiki/Ancon%C3%A6us_musclehttp://en.wikipedia.org/wiki/Triceps_brachii_musclehttp://en.wikipedia.org/wiki/Triceps_brachii_musclehttp://en.wikipedia.org/wiki/Brachioradialishttp://en.wikipedia.org/wiki/Brachialis_musclehttp://en.wikipedia.org/wiki/Muscle


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MovementsMovements

The hinge-li+e bending and straightening The hinge-li+e bending and straightening

fleion and etensionfleion and etension between the humerus between the humerus

and the ulna.and the ulna.

The comple action of turning the forearmThe comple action of turning the forearm

over over pronationpronationoror supinationsupination happens at the happens at the

articulation between the radius and the ulnaarticulation between the radius and the ulna

this movement also occurs at the wrist joint.this movement also occurs at the wrist joint.

The hinge moves in only one plane.The hinge moves in only one plane.
http://en.wikipedia.org/wiki/Anatomical_terms_of_motionhttp://en.wikipedia.org/wiki/Anatomical_terms_of_motionhttp://en.wikipedia.org/wiki/Pronationhttp://en.wikipedia.org/wiki/Pronationhttp://en.wikipedia.org/wiki/Supinationhttp://en.wikipedia.org/wiki/Supinationhttp://en.wikipedia.org/wiki/Supinationhttp://en.wikipedia.org/wiki/Pronationhttp://en.wikipedia.org/wiki/Anatomical_terms_of_motion


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The &The &rteriesrteriessupplying the joint are derived from thesupplying the joint are derived from theanastomosis between theanastomosis between theprofundaprofundaand the superiorand the superiorandand inferior ulnar collateralinferior ulnar collateralbranches of thebranches of thebrachialbrachial,,

with the anterior, posterior, and interosseous recurrentwith the anterior, posterior, and interosseous recurrentbranches of thebranches of the ulnarulnar, and the, and therecurrent branch of the radialrecurrent branch of the radial. These vessels form a. These vessels form acompletecomplete anastomoticanastomoticnetwor+ around the joint.networ+ around the joint.

The The erveservesof the joint are a twig from the ulnar, as itof the joint are a twig from the ulnar, as itpasses between the medial condyle and the olecranon/passes between the medial condyle and the olecranon/a filament from the musculocutaneous, and two froma filament from the musculocutaneous, and two fromthe median.the median.
http://en.wikipedia.org/wiki/Arterieshttp://en.wikipedia.org/wiki/Arterieshttp://en.wikipedia.org/wiki/Profunda_brachiihttp://en.wikipedia.org/wiki/Profunda_brachiihttp://en.wikipedia.org/wiki/Inferior_ulnar_collateralhttp://en.wikipedia.org/wiki/Inferior_ulnar_collateralhttp://en.wikipedia.org/wiki/Brachial_arteryhttp://en.wikipedia.org/wiki/Brachial_arteryhttp://en.wikipedia.org/wiki/Ulnar_arteryhttp://en.wikipedia.org/wiki/Ulnar_arteryhttp://en.wikipedia.org/wiki/Recurrent_branch_of_the_radialhttp://en.wikipedia.org/wiki/Recurrent_branch_of_the_radialhttp://en.wikipedia.org/wiki/Anastomotichttp://en.wikipedia.org/wiki/Anastomotichttp://en.wikipedia.org/wiki/Nerveshttp://en.wikipedia.org/wiki/Nerveshttp://en.wikipedia.org/wiki/Nerveshttp://en.wikipedia.org/wiki/Anastomotichttp://en.wikipedia.org/wiki/Recurrent_branch_of_the_radialhttp://en.wikipedia.org/wiki/Ulnar_arteryhttp://en.wikipedia.org/wiki/Brachial_arteryhttp://en.wikipedia.org/wiki/Inferior_ulnar_collateralhttp://en.wikipedia.org/wiki/Profunda_brachiihttp://en.wikipedia.org/wiki/Arteries


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Monteggia !a"t#!eMonteggia !a"t#!e

0 of upper third of ulna with dislocation of0 of upper third of ulna with dislocation of

head of radius.head of radius.

Head of radius is dislocated both from theHead of radius is dislocated both from the

radioulnar articulation and from elbow joint.radioulnar articulation and from elbow joint.

It may be displaced 1&nt,post,or laterally accIt may be displaced 1&nt,post,or laterally acc

to angulature of ulnar fracture.to angulature of ulnar fracture.


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DIAGNOSISDIAGNOSIS

very 0 of upper shaft of ulna without 0 ofvery 0 of upper shaft of ulna without 0 of

radial shaft should be considered to beradial shaft should be considered to be

monteggia 0 unless otherwise proved.monteggia 0 unless otherwise proved.

first 2 ray may show head of radius in itsfirst 2 ray may show head of radius in its

correct position, but serial 2 rays have to becorrect position, but serial 2 rays have to be

ta+en over 3ta+en over 3ststfew wee+s 1bco4 if dislocationfew wee+s 1bco4 if dislocation

has occurred and there is instability ,head ofhas occurred and there is instability ,head of

radius may redisplace later.radius may redisplace later.


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Dis$%a"ement-& t'$esDis$%a"ement-& t'$es

5onteggia 0 dislocations can ta+e place from5onteggia 0 dislocations can ta+e place from

6 forces and corresponding injuries seen.6 forces and corresponding injuries seen.

"#2I7 I8$%9"#2I7 I8$%9

2T)I7 I8$%92T)I7 I8$%9

&$;TI7 I8$%9&$;TI7 I8$%9

***Hume fracture***Hume fracture


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"#2I7 I8$%9-3"#2I7 I8$%9-3

0 ulna is angulated0 ulna is angulated

with the conveitywith the conveityposteriorly and theposteriorly and the

head of radius ishead of radius is

dislocateddislocated

bac+wards.bac+wards.


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E(TENSION IN)URY-*+-,.E(TENSION IN)URY-*+-,.

;ommonest type.;ommonest type.

0 ulna is angulated with coveity ant. and0 ulna is angulated with coveity ant. and

laterally.laterally.

?ith head of radius dislocated forwards and?ith head of radius dislocated forwards and

laterally.laterally.


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A//#"tion in0#!'A//#"tion in0#!'

;aused by adduction strain at the elbow.;aused by adduction strain at the elbow.

$lna is angulated laterally and radial head is$lna is angulated laterally and radial head is

displaced laterally.displaced laterally.


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1UME FRACTURE1UME FRACTURE

@@High 5onteggia injuryA.High 5onteggia injuryA.

3B=C Hume described --fracture of the3B=C Hume described --fracture of theolecranon with an associated anteriorolecranon with an associated anterior

dislocation of the radial head .dislocation of the radial head .

)een in ;hildren.)een in ;hildren.


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MEC1ANISM OF IN)URY2MEC1ANISM OF IN)URY2

5ervyn vans suggested this mech.5ervyn vans suggested this mech.

3**"all on outstretched hand with twisting of3**"all on outstretched hand with twisting of

the trun+,forcibly pronating the forearm.the trun+,forcibly pronating the forearm.

D**irect injury-&frica-irect blow on theD**irect injury-&frica-irect blow on the

bac+ of forearm with a stic+while arm is raisedbac+ of forearm with a stic+while arm is raised

warding off an attac+er.warding off an attac+er.


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TREATMENTTREATMENT

;7)%E&TIE;7)%E&TIE

7!%&TIE7!%&TIE


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CONSER3ATI3E4-CONSER3ATI3E4-

;hildren.;hildren.

manipulation and plaster immobilisation.manipulation and plaster immobilisation. 'ut close watch needed-recurrence of'ut close watch needed-recurrence of

deformity.deformity.


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Re/n2 o e5tension in0#!'2Re/n2 o e5tension in0#!'2

#ongitudinal traction of forearm with with the#ongitudinal traction of forearm with with the

elbow fleed as much as possible withoutelbow fleed as much as possible without

compromising the blood supply.compromising the blood supply.

"orearm is stable in supination"orearm is stable in supination

!laster windowed for radial pulse!laster windowed for radial pulse


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Re/n o a//#"tion in0#!'2Re/n o a//#"tion in0#!'2

Traction of the forearm with elbow etendedTraction of the forearm with elbow etended

and pressure over the head of radius, and afterand pressure over the head of radius, and after

redn.this 0 dislocation is stable with the elbowredn.this 0 dislocation is stable with the elbow

fleed.and with forearm supinated.fleed.and with forearm supinated.


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Re/n o %e5ion in0#!'Re/n o %e5ion in0#!'

Traction on forearm with elbow etende and asTraction on forearm with elbow etende and as

the redn is stable only in the etended positionthe redn is stable only in the etended position

1not advisable in adults.1not advisable in adults.


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O6ERATI3E TREATMENT2O6ERATI3E TREATMENT2

&dvisable in adults.&dvisable in adults.

7pen redn of 0 ulna and rigid int. fiation7pen redn of 0 ulna and rigid int. fiation

preferable with a plate..preferable with a plate..

islocation of head of radius red.islocation of head of radius red.

spontaneously when the deformity of ulna hasspontaneously when the deformity of ulna has

been reduced.been reduced.


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O6ERATI3E TEC1NI7UE2O6ERATI3E TEC1NI7UE2

0 of ulna is eposed ,reduced and fied by a0 of ulna is eposed ,reduced and fied by a

compression plate,or I5 nail.compression plate,or I5 nail.

Intraop ta+e ray elbow in D planes.Intraop ta+e ray elbow in D planes.

If head of radius is perfectly reduced, theIf head of radius is perfectly reduced, the

position is accepted and well padded plasterposition is accepted and well padded plaster

cast is applied from metacarpals to ailla- withcast is applied from metacarpals to ailla- with

elbow at right angles and forearm supinated.elbow at right angles and forearm supinated.


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If 2 ray shows 1head of radius is not reduced,If 2 ray shows 1head of radius is not reduced,

then it must be eposed and reduced underthen it must be eposed and reduced under

direct vision.direct vision.

&nnular lig. --usually cause obstruction-&nnular lig. --usually cause obstruction-

incised.incised.


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COM6LICATIONSCOM6LICATIONS

3.$%$; I)#7;&TI7 7" H&3.$%$; I)#7;&TI7 7" H&

7" %&I$).7" %&I$).

D.T%&$5&TI; 7))I"I;&TI7 &%7$D.T%&$5&TI; 7))I"I;&TI7 &%7$

%&I H&.%&I H&.

6.!I !)96.!I !)9

F.;%7)) $I7 'G? %&I$) & $#&.F.;%7)) $I7 'G? %&I$) & $#&.=.I)#7;&TI7 7" #7?% 7" $#&=.I)#7;&TI7 7" #7?% 7" $#&

.$-$IT 0 7" $#&..$-$IT 0 7" $#&.


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Un!e/2 /is%2 o 8ea/ o !a/i#s2Un!e/2 /is%2 o 8ea/ o !a/i#s2

%%

cision of displaced head of radius.cision of displaced head of radius.

!rod inc. elbow fleion and good range of!rod inc. elbow fleion and good range ofpronation and supination.pronation and supination.

7T done in ;HI#%.removal of upper7T done in ;HI#%.removal of upper

radial epiphysisineJuality of length ofradial epiphysisineJuality of length offorearm bones and cause further disl. of %$forearm bones and cause further disl. of %$

joints both sup. and inf.joints both sup. and inf.


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6IN 6ALSY6IN 6ALSY

;ommon with &dduction 0 dislocation.;ommon with &dduction 0 dislocation.

!rognosis good in early complete reduction of!rognosis good in early complete reduction of

head of radius.head of radius.

#ate !I palsy due to inadeJuate redn of#ate !I palsy due to inadeJuate redn of

radial head.radial head.


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C!oss #nion 9:; !a/i#s an/ #%na2C!oss #nion 9:; !a/i#s an/ #%na2

'ony fusion bGw nec+ of radius and 6 site of'ony fusion bGw nec+ of radius and 6 site of

upper 6rd of ulna.upper 6rd of ulna.

ifficult to %.ifficult to %.

' co4 proimity of elbow jt and !I.' co4 proimity of elbow jt and !I.

***%ecurrence is high.***%ecurrence is high.

***!erm limitation of %adioulnar movt.***!erm limitation of %adioulnar movt.


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Dis%o"ation o %o;e! en/ o #%naDis%o"ation o %o;e! en/ o #%na

%$;) with redn of ulnar shaft 0.%$;) with redn of ulnar shaft 0.

?7%)) if head of radius is ecised.?7%)) if head of radius is ecised.

% ecise distal inch of ulnar-if wrist% ecise distal inch of ulnar-if wristsymptoms.symptoms.


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Un #nite/ < o #%naUn #nite/ < o #%na

otorious for that.otorious for that.

%igid internal fiation and cancellous onlay%igid internal fiation and cancellous onlay

grafting.grafting.


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THANK YOU

dr mangala rajeevlklk-2

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