Proximal Ulna Metaphyseal Fracture with Dislocation and Radial Head Fracture (Monteggia Variant)

Enhance your skills in the treatment of one of the most challenging elbow injuries: the metaphyseal fracture of the proximal ulna associated with posterior dislocation and fracture of the radial head, known as the Monteggia variant. This training covers the anatomical reduction of the ulna and radial head, fixation with plates and screws, and the reinsertion of ligamentous structures, aiming to restore joint stability and allow early elbow mobility, minimizing tissue trauma and optimizing aesthetic outcomes.

Training Focus:

• Surgical treatment of the metaphyseal fracture of the proximal ulna with posterior dislocation and fracture of the radial head (Monteggia variant).
• Anatomical reduction of the ulna and the head of the radius.
• Stable fixation with plates and screws.
• Reinsertion of ligamentous structures.
• Restoration of joint stability and early mobility of the elbow.

Detailed Content:

• Surgical Positioning and Access: Patient in prone position, arm at 90°, with single posterior access, preserving the musculature and optimizing exposure.
• Reduction of the Ulna: Careful detachment of the periosteum and anatomical reduction based on the "fracture teeth."
• Access to the Radial Head: Lateral posterolateral approach via the anconeus, avoiding multiple planes. Enlargement with disinsertion of the lateral collateral ligament and controlled dislocation.
• Fixation of the Radial Head: Manual reduction with mini-fragment screws using a tripod technique with subchondral stability.
• Reinsertion of Ligaments: 5.0mm metal anchor for precise reinsertion of lateral structures, ensuring joint stability.
• Fixation of the Ulna: Anatomical reduction of the metaphyseal component and preparation of the bed for plate placement with minimal muscle damage.
• Plating and Closure: Fixed progressive fixation with dynamic and locked screws. Anatomical closure of the fascia and aponeurosis, guided by skin markings.
• Post-operative: Immediate mobility with release of flexion and pronation/supination. Extension limited to 45° in the first weeks to preserve stability.