Monteggia fracture & galeazzi fracture

Monteggia fracture & galeazzi fracture by Dr Bipul Borthakur

1. MONTEGGIA FRACTURE It denotes fracture of proximal ulna shaft with dislocation of radial head. Commonly seen in children MECHANISM OF INJURY: Fall on a out-stretched hand with forced forearm pronation or forced elbow abduction

2. MONTEGGIA FRACTURE CLINICAL FEATURES: Pain and swelling over the elbow External deformity of the forearm Bony crepitus and painful range of elbow and forearm movements Neurovascular examination – Radial nerve or PIN injury

3. MONTEGGIA FRACTURE INVESTIGATIONS: Plain radiograph of forearm with elbow and wrist joint Look for alignment of radial head with the capitellum

4. MONTEGGIA FRACTURE BADO CLASSIFICATION:-

5. MONTEGGIA FRACTURE TREATMENT:- Non-operative – reserved only for the pediatric population Closed reduction and casting Operative Closed reduction of the radial head with restoration of ulnar length is the rule CR or OR with TENS in adolescent age group OR with plate fixation in adults Physiotherapy – after 1 week if fixation is stable

6. MONTEGGIA FRACTURE COMPLICATIONS:- Nerve injury – radial or PIN Non-union Radial head instability – due to non-anatomic reduction of ulna

7. GALEAZZI FRACTURE It refers to fracture of diaphysis of radius at the junction of the middle and distal thirds with associated disruption of the distal radio-ulnar joint (DRUJ) It is a fracture of necessity MECHANISM OF INJURY:- Fall onto an outstretched hand with forearm pronation With forearm in supination – Reverse Galeazzi fracture

8. GALEAZZI FRACTURE CLINICAL FEATURES:- Pain, swelling and external deformity of the forearm Tenderness over the fracture site with crepitus, limited movements of wrist and forearm P ain over the wrist on stressing the DRUJ Neurovascular injury is rare

9. GALEAZZI FRACTURE INVESTIGATIONS:- Plain radiograph of the forearm with e lbow and wrist – anteroposterior and lateral view Radiological signs of DRUJ injury Fracture at the base of ulnar styloid Widened DRUJ on AP view Subluxed ulna on lateral view >5mm radial shortening

10. GALEAZZI FRACTURE TREATMENT:- Always operative Open reduction and internal fixation with TENS in paediatric patients; plate and screw fixation in adults Unstable DRUJ after radius fixation – K wire fixation for 6-8 weeks or immobilization in long arm cast for 4-6 weeks Physiotherapy – Early motion if DRUJ is stable after radius fixation

11. GALEAZZI FRACTURE COMPLICATIONS:- Early: Neurovascular injury is rare; seen in gunshot injuries and iatrogenic damage to nerves Compartment syndrome Late: Malunion and non-union Radioulnar synostosis Re-fracture after plate removal