- peak incidence is 4-10 years
- Montegia Elbow & Galeazi at the wrist
Montegia Classification
| Type | Description |
|---|---|
| I | Ulnar has apex anterior & the radial head is anterior (75%) – supinate arm |
| II | Posterior ulnar apex & posterior radial head- pronate arm |
| III | Lateral ulnar angulation & dislocation of the radial head – arm in neutral |
| IV | Anterior dislocation of the head & fracture of the shaft of the radius |
- Equivalents include physeal seperations & plastic deformation of the ulna
- Nerve palsy in 10% – 67%
Treatment
| Type | Treatment |
|---|---|
| Type 1 | >90° of elbow flexion & supination |
| Type 2 | elbow extension & pronation |
| Type 3 | 20 degree elbow flexion & neutral rotation |
| Type 4 | generally open reduction of forearm |
- Closed reduction & anatomic reduction of the ulna is required otherwise the radial head will not stay reduced
Open Technique
- If inadequate or unstable reduction
- Address the ulna first with a plate or IM technique
- Then reduce the radius, if the radius not reducing
- Open the radiocapitellar joint through the interval ECU & anconeus
- If still unreduced pin the joint
The Missed Montegia
- Progressive valgus deformity
- Unstable elbow in valgus
- Good results by reconstructing up to 4 years after the injury
- Arthrogram will show if it is congentital versus post-traumatic – based on hole in capsule if traumatic
- Make sure that this is not a congenital dislocation
- Evaluate the joint surface intraoperatively
- Open reduction of the radial head & release of the interposed annular ligament, ulnar osteotomy to address the bowing & ↑ length
- Internal fixation of the ulnar osteotomy
- Repair of the the annular ligament – Bell Toss if unstable – use a long slip of the triceps fascia & it is used to fashion a loop around the radial neck to hold the reduction
- If still unstable pin the radius to the capitellum
Galeazzi Fracture
- < 12 – closed reduciton of the radious & immobilization in supination
- if in doubt order a CT scan
- > 12 ORIF of the radius & possible closed reduction of the ulna, if stable immobilize in cast with supination, if unstable or not reducible open the drug dorsally & clean out the crap & then pin it with repair of the local TFCC