Executive Editor: James Hunter General Editor: Fergal Monsell

Authors: Andrew Howard, Peter Schmittenbecher, Theddy Slongo

Pediatric proximal forearm 21r-E/M, 21u-M Monteggia equivalent

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Glossary

General considerations

The Monteggia equivalent fracture involves a radial neck fracture and any ulnar fracture distal to the coronoid process.

Stabilize both bones to prevent late displacement and limited forearm function.

ESIN
Main indication Skill Equipment
Any unstable or displaced fracture Some specialized surgical experience Simple surgical and imaging resources

If elastic nails are not available, the ESIN method can be performed with long stainless-steel K-wires.

If closed reduction is not possible, an open reduction may be necessary.

This treatment can be performed if image intensifier is not available with fracture reduction under direct vision.

Advantages

  • Cast-free rehabilitation
  • Minimally invasive treatment
  • Good alignment of fracture fragments
  • Predictably good functional outcome

Disadvantages

  • Image intensifier recommended
  • Risk of nerve or tendon injury at entry point
  • Risk of infection
  • General anesthesia required
  • Second anesthetic required for implant removal
Open reduction; plate fixation (ulna)
Main indication Skill Equipment
Unstable injury in adolescents and young adults Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Advantages

  • Cast-free rehabilitation
  • Anatomical reduction of joint (may require overcorrection of the ulna)
  • Length stability

Disadvantages

  • Risk of infection
  • Neurovascular injury
  • General anesthesia required
  • Second anesthetic required for implant removal
  • Scar(s)
  • Demanding technique
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2019-08-28