Open Reduction Internal Fixation of a Monteggia forearm fracture dislocation using the Synthes small fragment LCP plate surgical technique
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Learn the Open Reduction Internal Fixation of a Monteggia forearm fracture dislocation using the Synthes small fragment LCP plate surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Open Reduction Internal Fixation of a Monteggia forearm fracture dislocation using the Synthes small fragment LCP plate surgical procedure.
A Monteggia fracture-dislocation is a fracture of the proximal one third of the ulna and an associated dislocation of the radial head and is named after Giovanni Battista Monteggia who described it in 1814. Monteggia fractures are thought to occur from a fall on to a hyper-pronated forearm / hand. They are relatively uncommon with an incidence of between 1% to 2% of all forearm fractures. They are more frequently seen in children compared to adults however, the literature and treatment options must be interpreted with caution as the groups are often mixed together.
The forearm comprises two bones (radius & ulna) that are held together at different levels by different soft tissue structures. Distally the forearm is connected at the Distal Radio-Ulna Joint (DRUJ) by the Triangular FibroCartilage Complex (TFCC). In the mid-portion the bones are connected by the interosseous membrane and proximally the radius is held by the annular and quadrate ligaments. The annular ligament arises from the anterior and posterior aspects of the radial notch in the proximal ulna. The annular ligament is a strong band of fibres that encircle the proximal radius, maintaining its position in the radial notch but also allowing it to freely rotate during supination and pronation. The quadrate ligament arises from the inferior border of the radial notch on the ulna and connects directly to the radial neck. Its’ function is to increase the stability of the Proximal Radio-Ulnar Joint (PRUJ) and restrict excessive supination / pronation.
The Synthes Locking Compression Plate (LCP) has uniformly spaced combination (combi) holes. The plate can be applied in any of the following modes:
- Tension band
The combi holes can accommodate standard cortical / cancellous screws and locking screws. The combi holes are a mirror image relative to the middle of the plate. This places the threaded hole section (for locking screws) closer to the fracture and the dynamic compression unit (DCU) side of the hole is furthest away from the fracture. This means that with eccentric cortical / cancellous screw placement, then compression is achieved at the fracture site.
As the plates allow the insertion of locking screws, this converts the construct into a fixed angle device and you do not need to rely on plate/bone compression to maintain the stability of the construct.
The small fragment LCP plates will accept the following screw sizes:
- 3.5mm cortical screws
- 4.0mm cancellous screws
- 3.5mm locking screws
Author: Mr Ross Fawdington FRCS (Tr & Orth)
Institution: The Queen Elizabeth Hospital, Birmingham, UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.