Fracture of the upper third of the ulna combined with dislocation of the radius head

　　Named after the two cases of ulnar shaft fracture in the upper third combined with radial head anterior dislocation reported by Nlanteggia in 1914. In 1967, Bado named the ulnar fracture combined with radial head dislocation as Monteggia fracture. The etiology of the disease is introduced in four types according to the mechanism of injury.

　　① Extension type:

　　Commonly seen in children, the characteristics are the ulnar shaft fracture in the upper middle third, angles to the palmar side, and there is a anterior dislocation of the radial head. It is usually caused by an indirect force due to the supination of the forearm when falling, and direct impact on the dorsal side of the ulna can also cause an extension type fracture.

　　② Flexion type:

　　Mainly in adults, the elbow joint is flexed, and the forearm is supinated when falling, with the palm of the hand on the ground. The ulnar shaft fracture in the upper middle segment angles to the dorsal side, and the radial head is dislocated posteriorly.

　　③ Adduction type:

　　Commonly seen in infants, fractures occur mostly at the epiphysis. The fracture angles to the radial side, and the radial head is dislocated to the radial side.

　　④ Special type:

　　The radial head is anteriorly dislocated, combined with the double fracture of the ulna and the upper third or middle upper third of the radius. This type accounts for about 5%, and it can occur in both adults and children. Most scholars believe that the mechanism of injury is the same as that of the extension type fracture, but it is also combined with a fracture of the radius, which may be caused by a second trauma to the radius after the radial head dislocation.

　　The above is the etiology of the ulnar shaft fracture in the upper third combined with radial head dislocation, which is very helpful for understanding the disease. If the disease is present, active treatment is needed, which can be surgical or conservative reduction treatment. The specific needs should be combined with the condition, and postoperative rehabilitation training should be paid attention to.

　　In the case of ulnar shaft fractures in the upper third combined with radial head dislocation, there is significant swelling and pain in the elbow joint and forearm. The patient cannot move the elbow joint or rotate the forearm. The most common complication is the injury to the deep branch of the radial nerve, which is related to the violent force and the local anatomical characteristics of the elbow joint. After the injury to the deep branch of the radial nerve, the wrist may not be extended, and there may be a reduction or disappearance of the palmar side sensation.

　　In 1914, the Italian surgeon Monteggia first reported this type of fracture, so it is called Monteggia fracture. It refers to a combined injury of fracture of the upper third of the ulna with anterior radial head dislocation. This injury can be seen in all age groups. So what are the clinical symptoms of this disease? According to clinical manifestations, this disease is mainly divided into four types, and the symptoms are as follows.

　　1. The extended type can be felt that the radial head is in the elbow pit, the forearm is shortened, and the ulna is forwardly angulated.

　　2. The flexed type can be felt that the radial head is behind the elbow, and the ulna is backwardly angulated.

　　3. The adducted type can be felt that the radial head and the proximal ulna are outwardly angulated at the lateral side of the elbow.

　　4. The special type has the radial head in front of the elbow, and the fracture site of the ulna and radius has deformation and abnormal movement.

　　The above are the clinical symptoms of fracture of the upper third of the ulna with anterior radial head dislocation. It is very helpful to understand this disease. If the above symptoms appear due to trauma, active examination and specific treatment are needed.

　　Fracture of the upper third of the ulna with radial head dislocation is caused by traumatic factors, so attention should be paid to safety in production and life to avoid trauma, which is the key to preventing the disease. In addition, it should be noted that after reduction and fixation, the flexion and extension of the finger and palm joints, the grip and the activity function of the shoulder joint should be exercised, such as 'clawing to increase strength', 'both hands supporting the sky' and so on. The elbow joint should not be moved prematurely, and the rotation of the forearm should be prohibited. In the first three weeks, the extension type and special type should be prohibited from extending the elbow, and the flexion type should be prohibited from flexing the elbow. After three weeks, the fracture is initially stable, and the elbow joint extension and flexion activities can be gradually performed, such as 'small cloud hand' and so on. However, the forearm should always maintain a neutral position, strictly prevent the rotation of the ulnar fracture site, otherwise it may cause delayed healing or non-healing of the fracture. After the splint is removed, strengthen the flexion and extension activities of the elbow, and start rotating activities such as 'twist the fist and turn the palm', 'rotate the elbow and twist the wrist'.

　　The auxiliary examination methods for fracture of the upper third of the ulna with radial head dislocation mainly include X-ray examination: the X-ray film should include the elbow joint to avoid missed diagnosis, pay attention to the anatomical relationship between the humerus and the radius, and take the contralateral X-ray film as a control when necessary. For any ulnar fracture above the upper segment, if the radial head dislocation is not seen on the X-ray film, it should be treated as such a fracture, because the radial head dislocation may sometimes be self-reduced, but the X-ray film must include the elbow and wrist joints, as there have been reported cases of Monteggia fracture and ipsilateral Colles fracture or Galeazzi fracture coexisting in clinical practice.

　　Fracture of the upper third of the ulna with radial head dislocation is a common disease in daily life. For patients with fracture of the upper third of the ulna and radial head dislocation, it is essential to strengthen nutrition. The following experts recommend a daily diet plan for these patients, hoping it will be helpful to them.

　　Firstly, dietary principles for patients with fractures of the upper third of the ulna with radial head dislocation:

　　For patients with fractures of the upper third of the ulna with radial head dislocation in the early stage, it is advisable to eat foods that activate blood circulation, remove blood stasis, reduce swelling, and relieve pain, such as panax notoginseng, hawthorn, allium fistulosum, shepherd's purse, leek, crab, etc.

　　For patients with fractures of the upper third of the ulna with radial head dislocation in the middle stage, it is advisable to eat foods that tonify the liver and kidney, and continue tendons and bones, such as goji berries, eucommia ulmoides, and bones of various animals.

　　If patients with fractures of the upper third of the ulna with radial head dislocation do not heal, they can eat foods that tonify Qi and blood, nourish the liver and kidney, such as purple carribean, longan meat, black beans, quail, etc.

　　Secondly, dietary plans for patients with fractures of the upper third of the ulna with radial head dislocation:

　　(1) Cow's knee wine.

　　Boil the cow's knee, remove the dregs, take the juice. Some of the juice is soaked in glutinous rice, and after the glutinous rice is cooked, the other part of the juice is mixed with sweet yeast and fermented at a warm place to make sweet wine. Take 50 grams twice a day and boil for consumption. For middle stages of fracture.

　　(2) Panax notoginseng steamed chicken.

　　Chicken meat 250 grams, panax notoginseng powder 15 grams, rock sugar (finely ground) as needed. Mix the panax notoginseng powder and rock sugar with the chicken slices, steam them in a sealed container over water. Eat in two servings a day. For early stages of fracture.

　　(3) Longevity pigeon egg soup.

　　Goji berries 10 grams, longan meat 10 grams, Chinese yam 10 grams, pigeon eggs 4, rock sugar 10 grams. Boil the three herbs in a pot until they are cooked, then add the eggs. Take once a day for 7 consecutive days. For later stages.

　　Feihua Health Network reminds you:As a whole, a person is an organic entity, where a change in one part affects the whole body. Therefore, traditional Chinese medicine believes that fractures of the upper third of the ulna with radial head dislocation can be treated by tonifying the kidney.

　　In 1914, Italian surgeon Monteggia first reported a combined injury of a fracture of the upper third of the ulna with anterior dislocation of the radial head, hence the name Monteggia fracture. Later, many scholars conducted further observations and mechanism studies on this injury, gradually expanding the scope of the injury concept, including radial head dislocation in all directions combined with different levels of ulnar fractures or double fractures of ulna and radius, which can be seen in all age groups, but is more common in children and adolescents. The treatment method for this disease is surgical treatment, and the specific treatment methods will be introduced below.

　　(1) Manual reduction and external fixation

　　1. Extended type

　　General anesthesia or brachial plexus anesthesia. The patient lies flat with the shoulders abducted and the elbow flexed 90°. The forearm is in a neutral position. After traction, the operator places the two thumbs on the lateral and palmar sides of the radius, exerting force to push the radius medially and dorsally to realign it. One assistant fixes the realigned radius and maintains traction, while the operator holds the proximal end of the ulna fracture with one hand and the distal end with the other, gradually increasing the angle towards the palmar side, then pulling it dorsally to realign it. If realigned, the elbow joint is immobilized with a cast or splint in an extreme flexed position for 2-3 weeks, then local fixation with paper padding splints is used. The elbow joint is exercised in a 90° flexed position until the fracture is completely healed.

　　2. Bending type

　　The anesthetic position is the same as that of the extension type. After the elbow joint is extended and traction is applied, the two thumbs push the radial head inward and towards the palm side. After reduction, one assistant fixes the radial head with the thumb and continues traction. The proximal and distal segments of the ulna fracture are held separately, and the angle is gradually increased towards the back side. Then press on the palm side, if the reduction is satisfactory, fix the elbow joint in a near extension position for 2 to 3 weeks with a palm-to-back plaster splint. Then use a paper pad short splint to fix the elbow joint at 90° of flexion to start exercising until the fracture heals.

　　3. Adduction Type

　　After the radial head is reduced by manipulation, the ulna can usually be reduced spontaneously. If there is slight angular deformation and the position of the radial head is not significantly changed, reduction is not required, and only a long arm cast is used to fix the elbow joint for 2 to 3 weeks. It is sometimes difficult to correct the ulnar deviation and angular deformation. Under traction, the elbow joint is flexed and externally rotated 90°, the fracture ends are pinched, the shoulder joint and upper arm are abducted 90°, then the operator pinches the proximal segment of the fracture towards the ulnar side and pulls it, the assistant at the distal end pulls the wrist towards the radial side with force, using the reduction of the radial head as a fulcrum, so that the distal segment of the ulna deviates towards the ulnar side and corrects the ulnar deviation towards the radial side.

　　(Two) Open Reduction and Internal Fixation

      For Monteggia fractures that cannot be reduced by manipulation or for those with radial head dislocation that cannot be reduced after reduction, early surgical reduction and internal fixation should be performed. First, the radial head dislocation is reduced, and the condition of the annular ligament injury is understood and repaired, and the ulna is fixed with medullary needles or steel plates and screws.

　　(Three) Treatment of Old Fractures of Monteggia

　　Adults with old fractures, the ulna has been corrected, the fracture has healed solidly, and only the rotation function of the forearm is limited. Resection of the radial head can improve the rotation function. If the ulna fracture has not healed, there is deformity, surgical correction of the fracture internal fixation can be performed, and the radial head can be reset. If the radial head cannot be reset, it can be resected. In children with old cases, the displacement of the ulna fracture is not large, and it does not affect the复位 of the radial head, so it does not need to be treated. If the deformity is obvious, it must be corrected, and the medullary needle fixation is used to facilitate the复位 of the radial head. After the radial head is复位, repair or reconstruct the annular ligament. For those who cannot复位 the radial head, it is not recommended to resect the radial head to avoid affecting the development of the radius, and it can be resected after adulthood.

　　The above is the treatment method for fractures of the upper 1/3 of the ulna with anterior dislocation of the radial head. Attention should be paid to postoperative rehabilitation training and actively restore joint function.