An open reduction of the ulna fracture and radial head with reconstruction of the annular ligament was reserved for chronic cases. Cunningham advocated an immediate reduction of the radial head with simultaneous closed reduction of the ulna fracture. ( 10- 11) Wilson reported 3 cases of Monteggia fracture-dislocation among 439 patients while Cunningham reported 14 cases in a series of 257 patients after excluding fractures of the olecranon and styloid process. Wilson (1933) in New York and Cunningham (1934) in Oklahoma both presented large numbers of consecutive patients with elbow injuries and formally discussed the management of Monteggia fracture-dislocations. Perrin in France coined the term Monteggia fracture-dislocation in 1909 in his publication Thesis de Paris. He treated it by an open reduction technique instead of fracture manipulation and closed reduction that was traditionally used to treat forearm fractures at that time. His series included 10 patients, and he referred to a case that appeared to be one of the earliest descriptions of a known chronic injury. Stimson gave a brief account of his personal experience with Monteggia fracture-dislocation in his book ‘Practical Treatise on Fractures and Dislocations’. Doerfler reported 4 cases including a patient who experienced paralysis of the extensor muscles of the forearm owing to injury of the posterior interosseous nerve that was caused by the dislocated head of the radius. ( 7- 9) Malgaigne reported that a fracture of the shaft of the ulna with dislocation of the head of the radius was not uncommon and warned that with any fracture of the ulna, a dislocation of the radius should be considered and vice versa. ( 6) Shortly after, the fracture pattern received the attention of other authors such as Malgaigne in France (1854), Doerfler in Germany (1886) and Stimson in the United States (1900). In 1844 Cooper, from London, England, described anterior, posterior, and lateral dislocations of the radial head with fracture of the ulna shaft. In the current period (1991 and onwards), better results have been obtained as a result of prompt recognition of the injury and improved plate fixation techniques that have allowed anatomic reduction of the ulna and restoration of normal contour of the trochlear notch. There was also an increased awareness of the mechanism of the injury and variations of the original injury, namely the Monteggia lesion and its equivalents. In the intermediate period (1940–1990), the availability of implants made open reduction and internal fixation of the ulna shaft possible. In the early period (1814–1939), the components of the Monteggia injury were identified, and the importance of reducing the radial head and ulna shaft fracture became apparent. The evolution of management of Monteggia fracture-dislocations can be considered in 3 chronological periods. From these original materials, we present the evolution of treatment of Monteggia fracture-dislocations over 2 centuries and summarize the lives and contributions of Monteggia and Bado.Ĭover page of Givoanni Monteggia textbook Istituzioni Chirurgiche second edition published in 1814 including the original description of the Monteggia fracture. Finally, we contacted family friends and colleagues of Professor Bado. Additionally, we collected information from online databases such as the History of Medicine and translated original articles from Italian and Spanish. A literature search was conducted that included the archives of the libraries of our home institution, University of the Republic, Montevideo, Uruguay, the University of Milan and the University of Pavia in Italy. Bado included a group of injuries having in common a dislocation of the radial head associated with fractures at various levels of the ulna or with injuries at the wrist.Īlthough the eponym Monteggia fracture-dislocation is well recognized by orthopedic surgeons, little is known about the lives and contributions of Monteggia and Bado and the evolution of treatment of this complex injury. ( 3- 5) He introduced the concept of a Monteggia lesion and Monteggia equivalent injuries. ( 2) In 1958, Jose Luis Bado, a professor of orthopedic surgery from Uruguay, elaborated on the pathomechanics and management of this fracture-dislocation in a monograph that was first published in Spanish then later in English. ( 1) This injury pattern was eponymously named as the Monteggia fracture-dislocation by Perrin in 1909. A fracture of the shaft of the ulna associated with an anterior dislocation of the radial head was described by an Italian surgeon, Giovanni Battista Monteggia, in 1814.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |