• 30 year old male patient
• History of road traffic accident
• C/o left elbow pain foream pain and open wound over 3^rd finger
• On xray : left elbow dislocation  and radius shaft fracture
• 3^rd finger interphalangeal joint dislocation

PRE OP X RAYS AND CT SCAN

AIMS AND OBJECTIVES

To give primary management by reduction and application of slab for support

To achieve definitive fixation by –

1. Fixing radial shaft

2.Stabilising elbow joint

METHODS AND PROCEDURE

• To access the forearm region using thompson approach
• The incision from anterior and distal to lateral epicondyle of humerus to distal and ulnar to lister’s tubercle
• The interval between extensor digitorumcommunis and extensor carpi radialisbrevis
• To access the elbow region using over the top hotchkiss approach
• The interval that splits the flexor pronator mass and elevates anterior part( pronator teres, palmarislongus, flexor carpi radialis, palmarislongus along with brachialis) from the anterior elbow capsule

THOMPSON APPROACH

HOTCHKISS OVER THE TOP APPROACH

INTRA OPERATIVE

1. Radius shaft fixed – no stability
2. Fragment involved – anterolateral fragment involved with tip of coronoid
3. Fracture fragment identified – fix with herbert screw

4.After fixation of elbow joint

5. No need of collateral ligament fixation

25 PERCENT OF ANTEROMEDIAL, TIP PORTION AND BASAL PORTION

O’DRISCOLL CLASSIFICATION

INTRA OPERATIVE PICTURES

CONCLUSION

The over the top hotchkiss approach for the fixation of fracture in this case, is a very efficient and efficacious fixation technique for the clinical, radiological and functional betterment and outcome for the patient.

RESULTS AND DISCUSSION

• The fracture fragment involved is not a part of the o’driscoll classification
• Hence this case is a new variant of monteggia fracture
• The movement at the elbow joint has been restored and the patient is not having any major complaint
• The functional outcome of the procedure has aided the enhancement of the quality of life of the patient

POST OPERATIVE X RAY