Fracture of the upper third of the ulna with dislocation of the radial head

Introduction of 1/3 of the ulna and fracture of the humeral head In 1914, the Italian surgeon Monteggia first reported this type of fracture, so it was called a Monteggia fracture. A joint injury involving a 1/3 fracture of the ulna and a forward dislocation of the humeral head. Later, many scholars made further observations and mechanism research on this kind of injury, which gradually expanded the scope of the injury concept. The dislocation of the humeral head and the different levels of ulnar fracture or both ulnar and humeral fractures were included. Can be seen in all age groups, but more common in children and adolescents. basic knowledge The proportion of sickness: 0.01%-0.05% Susceptible people: more common in children and teenagers Mode of infection: non-infectious Complications: fracture

The cause of 1/3 fracture of the ulna and the cause of dislocation of the humeral head

The disease is mainly divided into four types, and its pathogenesis is as follows:

Straight type:

More common, mostly occurs in children, the elbow joint is straight or overstretched, the forearm is rotated, the palm touches the ground, the body gravity is transmitted down the tibia, first causing a 1/3 oblique fracture of the ulna, and residual violence forces the humeral head. Dislocation of the front and the outer side, the fracture end is angled to the volar side and the temporal side. Because of the direct violence, the fracture is mostly transverse or crushed.

Flexion type:

More common in adults, elbow joint micro-flexion, forearm proximate palm touch the ground, the force first caused the ulnar horizontal plane or short oblique fracture, the humerus dislocated to the posterior lateral, the fracture end to the dorsal and temporal side angle.

Admission type:

It occurs mostly in young children, the elbow joint is straight, the forearm is pre-rotation, the upper limb is slightly retracted and falls forward, and the violence is pushed from the elbow to the outside, causing the ulnar condyle to traverse or longitudinal cleft palate, with less displacement. The humeral head is dislocated outward.

Special type:

The humeral head dislocation forward, combined with ulna and upper 1/3 or middle 1/3 double fracture of the humerus. This type accounts for about 5%, which can occur in both adults and children. Most scholars believe that the injury mechanism is the same as that of the straight fracture. However, combined with a fracture of the tibia, the tibia may be affected by a second trauma after dislocation of the humeral head.

Upper 1/3 fracture of ulna with humeral head dislocation prevention

The disease is caused by traumatic factors, so pay attention to production and life safety, avoiding trauma is the key to prevent this disease.

In addition, it should be noted that after the fixation is fixed, the finger joint, the flexion and extension of the palm joint, the fist movement and the active function of the shoulder joint should be used, such as catch the air force, hands hold the sky, etc., do not prematurely move the elbow joint. It is forbidden to rotate the forearm. In 3 weeks, the straight type and the special type are forbidden to perform the elbow movement. The flexion type is forbidden to bend the elbow. After 3 weeks, the fracture is initially stable, and the elbow joint extension and flexion activities can be gradually performed, such as "Xiao Yunshou" "Whether, but the forearm should always maintain a neutral position, strictly prevent the rotation of the ulnar fracture, otherwise it may cause delayed fracture healing or non-healing. After dismantling the splint, strengthen the flexion and extension of the elbow, and start the rotation activity, such as "twisting "The palm", "the elbow and the wrist" and so on.

Upper 1/3 of the ulna with complication of humeral head dislocation Complications

In all four types of fractures of this disease, the elbow joint and forearm have obvious swelling, pain, tenderness, the patient can not move the elbow joint and rotate the forearm, and the deep branch of the radial nerve is the most common complication, its occurrence and violence and elbow The local anatomical features of the joint are related. After the deep branch of the radial nerve is damaged, the wrist may not be straightened, and the dorsal side of the tiger's mouth may be reduced or disappeared.

Upper 1/3 fracture of the ulna with humeral head dislocation symptoms Common symptoms Forearm rotation pain Forearm shortening joint pain Elbow dislocation of the wrist joint blood and ... Forearm pronation deformity elbow severe pain, ...

First, according to clinical manifestations, the disease is mainly divided into four types:

1. The straight type can touch the humeral head in the elbow socket, the forearm is shortened, and the ulna is angled forward.

2, the flexion type can touch the humeral head behind the elbow, and the ulna is angled backward.

3, the adduction type can reach the humeral head and the proximal end of the ulna to form an angle outward on the elbow.

4. The special type of humeral head is in front of the elbow, and there are deformities and abnormal activities in the fracture of the radius and ulna.

Examination of 1/3 of the ulna and fracture of the humeral head

The auxiliary examination method for this disease is mainly X-ray examination:

The X-ray film should include the elbow joint to avoid missed diagnosis, pay attention to the anatomic relationship of the ankle joint. If necessary, take the X-ray film of the healthy side as a control. If the upper ulna fracture is broken, and the X-ray film does not see the dislocation of the humeral head, it should be pressed. Fracture treatment, because the humeral head sometimes resets itself after dislocation, but the X-ray film must include the elbow joint and the wrist joint, due to clinical reports of Monteggia fracture and ipsilateral Co lles fracture or Gai Azi (Galeazzi Cases with simultaneous fractures.

Diagnosis and differentiation of upper 1/3 fracture of ulna and humeral head dislocation

diagnosis

The disease is easily misdiagnosed for the following six reasons:

1. The X-ray film does not include the elbow joint.

2. The X-ray machine tube is not centered on the elbow joint, so that the dislocation of the humeral head becomes inconspicuous.

3. The existence of dislocation of the humeral head was neglected during the physical examination, so that this was not noticed when reading the film.

4. After the patient was injured, he had done a pulling brake to make the dislocated humeral head regained position, so that no dislocation was found when he came to the hospital for examination, but he could relapse and dislocate during fixation.

5. Ignore the presence of longitudinal or green branch fractures in the upper ulnar (especially near the olecranon).

6. There is insufficient understanding of the X-ray anatomical relationship of the elbow in children. The X-ray anatomical relationship of the elbow of the child is judged according to the corresponding position of the epiphysis at the joint end. The normal humeral head is opposite to the humeral head, and the longitudinal axis of the humerus is extended upward. It is necessary to pass the center of the humeral head, and the small skull of the humerus usually appears in the age of 1 to 5 years. Therefore, for children under 1 year old, it is best to take a healthy X-ray film for comparison.

Differential diagnosis

In addition, the disease needs to be differentiated from the fracture of the tibia, the fracture of the radius and the bone, and the dislocation of the humerus.

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