Transolecranon Fracture-Dislocation of the Elbow (Monteggia Variant) – "Pull-out" Technique

Master the surgical treatment of complex elbow fractures-dislocations, such as the Monteggia variant. This training details the reconstruction of the anterior joint capsule using the "pull-out" technique and the subsequent reduction and fixation of the ulnar fracture, aiming to restore stability and joint congruence of the elbow.

Training Focus:

• Treatment of transolecranon fracture-dislocation of the elbow (Monteggia variant).
• Reconstruction of the anterior joint capsule using the "pull-out" technique.
• Reduction and fixation of multifragmentary proximal ulnar fractures.
• Restoration of stability and joint congruence of the elbow.

Detailed Content:

• Positioning and Access: Patient in prone position with elbow at 90°. Dissection through planes with single access, retracting muscles around the ulna.
• Capsule Repair (Pull-Out Technique): Identification of the capsule and the coronoid process due to the fracture of the olecranon. Passage of high-strength wires and creation of tunnels to pull the capsule to the site of detachment, assisted by elbow flexion.
• Reduction of the Ulna: Fracture reduction with Kirschner wires.Lateral fragment fixation with a mini-fragment plate, enabling the use of a long plate on the olecranon.
• Finalization and Stabilization: Pull-out tying and definitive fixation with a long locked plate on the ulna metaphysis, ensuring joint stability.
• Closure and Final Result: Linear opening of the musculature, reconstructed fracture, and congruent joint. Well-distributed screws, with anatomical closure by layers.