tailieunhanh - Báo cáo y học: " Use of intra-medullary stacked nailing in the reduction of proximal plastic deformity in a pediatric Monteggia fracture: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Use of intra-medullary stacked nailing in the reduction of proximal plastic deformity in a pediatric Monteggia fracture: a case report. | Lim and Huntley Journal of Medical Case Reports 2011 5 153 http content 5 1 153 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Use of intra-medullary stacked nailing in the reduction of proximal plastic deformity in a pediatric Monteggia fracture a case report Jason Lim1 and James S Huntley2 Abstract Introduction In a Monteggia fracture dislocation it is important to reduce the ulnar fracture completely. Extensive plastic deformation of the proximal ulna may make reduction by closed manipulation impossible. Case presentation We report the case of a four-year-old Caucasian boy in whom the plastic deformation of the proximal ulna was reduced and this reduction was maintained using intra-medullary stacked nailing. Conclusion The technique of stacked nailing is a useful addition to the armamentarium in the management of the potentially awkward Monteggia fracture. Introduction A Monteggia fracture is a fracture of the ulna associated with a radio-capitellar dislocation 1 2 . Pediatric Monteggia injuries in contrast to those of adults are usually managed effectively by closed reduction 1 . In a recent one-year series of forearm fractures in Glasgow Monteggia fracture dislocations accounted for only a minority of injuries 4 ex 317 3 . Though uncommon it is vital to recognize the radio-capitellar dissociation early. The ulnar fracture is usually apparent on clinical and radiological assessment but up to 50 of radio-capitel-lar dissociations are missed by senior house officers and 25 are not recognized by senior radiologists 4 . In our center a review of Monteggia fracture dislocations between 1992 and 2001 showed that about 20 eight of 39 were initially missed 5 . Adequate treatment is important for achieving good results and to avoid secondary corrective surgery as missed Monteggia lesions or chronic radial head dislocations may require later reconstruction which is fraught with potential complications 6 . The current classification of