Bhattarai Ashbin, Subedi Dipendra, Bhandari Jyotsna, Homagain Sushan, Ghimire Jeevan, Paudel Suruchi, Sapkota Bipin, Dangol Sunil
National Trauma Center, National Academy of Medical Science, Kathmandu.
Dhading Hospital, Dhading.
Ann Med Surg (Lond). 2024 Aug 6;86(10):6145-6148. doi: 10.1097/MS9.0000000000002410. eCollection 2024 Oct.
The Monteggia equivalent type 1b fracture, consisting of an ulnar shaft fracture and radial head dislocation, is a rare condition first described by Giovanni Battista Monteggia. The Metaizeau technique, emphasizing percutaneous intramedullary fixation to preserve bone healing and prevent growth plate damage, has gained prominence in managing these fractures.
A 10-year-old boy presented with left forearm pain, swelling, and deformity following a fall while playing football. X-rays revealed a proximal fourth ulnar fracture with dorsal and lateral angulation, along with a proximal radial metaphyseal fracture showing anterior rotation and physeal extension. This fracture pattern resembled a Monteggia fracture type III but differed in the lateral proximal radial disruption via a Salter-Harris type II fracture rather than radial epiphysis dislocation. Satisfactory reduction achieved for ulna was managed with standard nailing system but could not be achieved for radial physeal injury, which was managed with Metaizeau technique.
Type 1b Monteggia equivalents involving a Salter-Harris type 2 fracture of the proximal radius with an associated proximal ulnar fracture, adherence to Monteggia fracture reduction principles is vital. Closed reduction and internal fixation are preferred treatments, with the Metaizeau technique offering advantages such as minimal invasiveness and avoidance of implant-related complications. The Metaizeau technique is particularly beneficial for displaced radial neck fractures in children, providing stable fixation while preserving the fracture environment necessary for optimal healing.
In cases of Monteggia fracture equivalents, most proximal radial fractures typically reduce to an acceptable level following ulnar reduction. However, proximal radial physeal fractures may require specific attention to achieve satisfactory reduction. The Metaizeau technique, commonly employed in the management of isolated radial neck fractures, can be utilized to achieve this reduction to an acceptable level.
蒙泰吉亚等效1b型骨折，由尺骨干骨折和桡骨头脱位组成，是一种罕见病症，最初由乔瓦尼·巴蒂斯塔·蒙泰吉亚描述。梅泰佐技术强调经皮髓内固定以促进骨愈合并防止生长板损伤，在处理这些骨折方面已受到广泛关注。
一名10岁男孩在踢足球时摔倒后出现左前臂疼痛、肿胀和畸形。X线显示尺骨近端四分之一骨折伴背侧和外侧成角，以及桡骨近端干骺端骨折伴前旋和骨骺延伸。这种骨折类型类似于蒙泰吉亚III型骨折，但不同之处在于桡骨近端外侧通过Salter-Harris II型骨折而非桡骨骨骺脱位。尺骨骨折通过标准钉系统实现了满意复位，但桡骨骨骺损伤无法实现满意复位，采用梅泰佐技术进行处理。
1b型蒙泰吉亚等效骨折涉及桡骨近端Salter-Harris 2型骨折并伴有尺骨近端骨折，遵循蒙泰吉亚骨折复位原则至关重要。闭合复位和内固定是首选治疗方法，梅泰佐技术具有微创性和避免植入物相关并发症等优点。梅泰佐技术对儿童移位性桡骨颈骨折特别有益，可提供稳定固定同时保留最佳愈合所需的骨折环境。
在蒙泰吉亚等效骨折病例中，大多数桡骨近端骨折通常在尺骨复位后可恢复到可接受水平。然而，桡骨近端骨骺骨折可能需要特别关注以实现满意复位。常用于处理孤立性桡骨颈骨折的梅泰佐技术可用于将这种骨折复位至可接受水平。
