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

Master the surgical treatment of complex elbow fracture-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 the stability and articular congruency of the elbow. 

Focus of the Training:

• 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 fractures of the proximal ulna.
• Restoration of stability and articular congruency of the elbow.

Detailed Content:

• Positioning and Approach: Patient in prone position with the elbow at 90°. Dissection by planes with a single approach, retracting muscles around the ulna.
• Capsular Repair (Pull-out Technique): Identification of the capsule and the coronoid process through the olecranon fracture. Passage of high-strength sutures and creation of tunnels to pull the capsule to its disinsertion site, aided by elbow flexion.
• Reduction of the Ulna: Reduction of the fracture with Kirschner wires. Fixation of a lateral fragment with a mini-fragment plate, enabling the use of a long plate on the olecranon.
• Finalization and Stabilization: Tying of the pull-out sutures and definitive fixation with a long locking plate on the metaphyseal ulna, ensuring joint stability.
• Closure and Final Result: Linear opening of the musculature, reconstructed fracture, and congruent joint. Well-distributed screws, with anatomic layer-by-layer closure.

Included Material:

• Detailed PDF of the Procedure: A document describing the surgical treatment of a complex elbow fracture-dislocation, including positioning, surgical approach, identification and repair of the anterior joint capsule with the "pull-out" technique, reduction and fixation of the ulna fracture, finalization of the "pull-out," plating, and closure.

Enhance your skills in elbow surgery.Enroll now and master the advanced techniques for treating complex fracture-dislocations, ensuring joint stability and function for your patients.