Name:
6 Months Old Neglected Monteggia Lesion in a Blind Woman - Surgical Treatment
Description:
6 Months Old Neglected Monteggia Lesion in a Blind Woman - Surgical Treatment
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T00H08M22S
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https://cadmoreoriginalmedia.blob.core.windows.net/ba50f133-7136-47c1-9ee7-ec12fa1e88ad/06 MONTHS OLD NEGLECTED MONTEGGIA LESION IN A BLIND WOMAN - .mp4?sv=2019-02-02&sr=c&sig=3mtaGkzfZImrtmT6kFKse5cUcmhlscXCha4x37vdT90%3D&st=2024-11-23T11%3A35%3A45Z&se=2024-11-23T13%3A40%3A45Z&sp=r
Upload Date:
2024-06-01T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Hello, my friends, how are you? This is me, Dr. Sergio Rowinski, from shoulder planet, here from the city of Sao Paolo, Brazil. In this nice presentation, I'm showing you a complex case, in a '64 year old lady, who had a sequela of a Monteggia lesion, in the right elbow. So the case was operated seven months after the trauma.
The surgery was very difficult, and we achieved a lovely final clinical result. So I hope you like the video. Please don't forget, Subscribe leave your comment. Give us your thumbs up, and let's see the video. Monteggia lesions are known to be quite complex lesions that can occur in the elbow, ,and its treatment can be even more complex when they are not properly recognized, in an acute setting.
So this case is about a 64-year-old woman, who is diabetic, and completely blind, too. This patient had felt over her right arm, in September 2009, in which much probably had a Monteggia lesion, that unfortunately was not properly diagnosed. This patient came to me in March 2010, complaining of pain and severe limitation on her right arm. Clinically, she had a huge deformity in her right elbow, that was literally crooked, as we can see in this photo.
Also, it seemed that not only she had had a fracture in her right elbow, but that it had healed in quite a varus position, too. In this photo, we can see that her right forearm was shortened, and that she had severe pain in her wrist, too, in the distal radio-ulnar joint. In this lateral view, we can see that she could extend her right arm, but not fully pronate her right forearm and her right hand, and she complained a lot, of not having a functional pronation for her daily activities.
In this photo, it's clear that her right elbow and could not flex more than 80 to 90 degrees, and due to that, she could not touch her mouth or her head with her right hand. AP x-rays revealed that there was a severe nonunion in proximal ulna, and that the proximal ulna had a huge varus deformity. Also, radial head had quite disappeared, and the radial neck was literally touching the capitellum.
Lateral X-ray revealed a clear nonunion in the proximal ulna, and the huge distortion of all elbow bony anatomy. In this picture, we can see a 3D CT medial view, in which it was clear that there was a big butterfly fragment, that definitely was not healed to any other bony piece. This is a 3D CT lateral view in which we can see that the radial neck was really touching the capitellum, and almost articulating with it.
In this image, we can see a 3D CT anterior view, in which we can see that huge butterfly fragment, and it's clear that it had not healed to the proximal or the distal fragments of the ulna. This is a 3D CT posterior view, in which we can see that the proximal ulna had a massive deformity in a varus position. So this patient was operated in April 2010.
We performed an extended BOYD'S approach, and ulnar nerve was carefully isolated. Here, in this picture, we can see all fragments cleaned, and, at that moment, the elbow was quite disassembled. In this movie, we can see all fragments released from scary tissue, and only after that we would be able to assemble the elbow again.
So we put a radial head prosthesis, and a locked plate in the Ulna, as we have seen here. And in this particular case, I prefer to cement the radial head prosthesis. This is a lateral view of the elbow, with the final construct, in which we can see the plate. And here, in this video, we can see that the elbow had full range of motion just after
all the construction was made. The ulnar nerve was anteriorized in the subcutaneous tissue, in the end of the surgery. In this picture, we can see the patient, after one week of surgery, physical therapy was started very soon. And this is the lateral X-ray, taken the day after surgery. We can see that the elbow anatomy was then fully restored.
This is the AP view, the X-ray AP view, taken the day after surgery, too, in which we can see that the butterfly fragment was not fully resected. I didn't feel very comfortable to resect it, during surgery, because it was too close to the anterior capsule, and I wanted to avoid vascular or neurological problems in surgery. And also, during surgery, it was very clear that remaining butterfly fragment would not bring problems to elbow motion, too.
This is the X-ray lateral view, taken six weeks after surgery, in which we can see that the proximal ulna was healing, and that some heterotopic bone was developing in that area. This is the X-ray lateral view, taken four months after surgery, in which we can see a bigger amount of heterotopic bone. And we can also see that the proximal ulna was healing quite good.
And finally, this is the X-ray lateral view taken six months after surgery, in which we can see a huge amount of heterotopic bone. The patient was absolutely free of pain at that moment. In this picture, taken six months after surgery, we can see that the prior deformity was fully corrected, comparing the right arm to the left arm. Now, the patient can touch her head again, with the right hand, and can perform her daily activities, like brushing her hair or even brushing her teeth.
In this photo, we can see the patient touching her mouth with her right hand. The patient gained, with this surgery, not only elbow flexion, but forearm pronation, which helped her a lot on her daily activities. Finally, in this photo, we can compare the clinical aspect of the upper right extremity. And so after surgery, the elbow anatomy was restored, both radiographically and clinically, as we can see in this final photo, taken seven months after surgery.
Thank you. So thank you, my friends, for watching the video, of this nice and difficult case, so please, don't forget, subscribe. Give us your thumbs up. Leave your comment. And as Dr. Sergio always says, never stop flying. See you, my friends.
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