King Fahd Hospital -Medina Munawrah-Orthopedic Surgery Department

           

A 5 years old male child who had  his rt. Arm jammed in the dryer of the washing machine presented with severely swollen limb with complete radial nerve paralysis.

X Ray showed comminuted  Fracture middle 1/3 rt. Humerus, Fracture. Radius and ulna + superior radioulnar dislocation (montagia variant lesion).

He was taken to OR for decompression for impending compartmental syndrome.

    

Under GA both arm and forearm were decompressed by fasciotomy through extended Henry approach. The ulna was reduced and fixed by interamedullary K- Wire as well as the radius which was reduced closely.

There was doubt about the superior radio-ulnar joint. Arthrography of  the elbow joint under image was done revealed complete Fracture of the radial head which was dislocated posterior. ORIF of radial head with K- Wire carried out.

Ex. Fix was applied to the humerus but reduction could not be achieved . exploration of the Fracture site revealed intrapment of the radial nerve in the Fracture site . The nerve was mobilised away. The nerve was contused, Fracture reduced and external fixation applied. All wounds were left open.

Postoperatively the circulation was satisfactory, full painless movement could be achieved.

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