PDF
ePub
Citation
Print
Abstract
Purpose
Our purpose is to evaluate the results of the operative treatment in neglected Monteggia fracture-dislocation in children.
Materials and Methods
We retrospectively analyzed 10 elbows in 10 patients who underwent surgery. All patients were classified as Bado type I, except one with type III. The mean duration of follow up was 2 years and 5 months. The mean age at the time of operation was 10 years and the mean time from injury to operation was 7 months. All 10 patients underwent open reduction of the radial head and reconstruction of annular ligament. Ulnar osteotomy was performed in 9 cases. Clinical assessment was done by Bruce et al.'s rating system.
Results
All 10 patients gained a mean of 35° of extension-flexion arc, however lost a mean of 29° of pronation-supination arc. And there were three complications, including dislocation of radial head in two patients and breakage of transarticular K-wire in one patient. According to Bruce et al.'s rating system, there were 4 excellent, 1 good, 3 fair, and 2 poor results.
Figures and Tables
Fig. 1
(A) Radiographs from a 8-year-old boy obtained at 3 months after trauma show an anterior dislocation of the radial head and a plastic deformation of the ulna. He had been immobilized with long arm cast for 2 weeks immediately after the injury. (B) Open reduction, reconstruction of the annular ligament and ulnar osteotomy were performed 3 months after the injury. (C) AP and lateral radiographs following 2 years show the normal alignment of radiocapitellar line and negative ulnar bow sign with no pain, no deformity and good function. But the range of pronation was decreased from 80° to 20°.
Fig. 2
(A) Anterior and lateral radiographs of the forearm show an anterior dislocation of the radial head. (B) Open reduction of the radial head, ulnar osteotomy and annular ligament reconstruction were performed 3 months after the injury. (C) At 4 months after operation, he was fallen on elbow and then, redislocation of the radial head was detected. (D) Anterior dislocation of the radial head has persisted for 2 years after the surgery, but there has been no pain and no decrease of range of motion.
References
1. Best TN. Management of old unreduced Monteggia fracture dislocations of the elbow in children. J Pediatr Orthop. 1994. 14:193–199.
2. Devnani AS. Missed Monteggia fracture dislocation in children. Injury. 1997. 28:131–133.
3. Freedman L, Luk K, Leong JC. Radial head dislocation after a missed Monteggia fracture: brief report. J Bone joint Surg Br. 1988. 70:846–847.
4. Guistra PE, Killoran PJ, Furman RS, Root JA. The missed Monteggia fracture. Radiology. 1974. 110:45–47.
5. Hurst LC, Dubrow EN. Surgical treatment of symptomatic chronic radial head dislocation: a neglected Monteggia fracture. J Pediatr Orthop. 1983. 3:227–230.
6. Bado JL. The Monteggia lesion. Clin Orthop Relat Res. 1967. 50:71–86.
7. Bruce HE, Harvey JP Jr, Wilson JC Jr. Monteggia fractures. J Bone Joint Surg Am. 1974. 56:1563–1576.
8. Heinrich SD, Butler RA. Late radial head dislocation with radial head fracture and ulnar plastic deformation. Clin Orthop Relat Res. 2007. 460:258–262.
9. Lincoln TL, Mubarak SJ. Isolated traumatic radial head dislocation. J Pediatr Ortho. 1994. 14:454–457.
10. Hudson DA, De Beer JD. Isolated traumatic dislocation of the radial head in children. J Bone joint Surg Br. 1986. 68:378–381.
11. Kemnitz S, De schrijver F, De Smet L. Radial head dislocation with plastic deformation of the ulnar in children. A rare and frequently missed condition. Acta Orthop Belg. 2000. 66:359–362.
12. Wouters E, Fortems Y, Mulier E, Stuyck J, Fabry G. Isolated posterior dislocation of the radial head without fracture of the ulna in a child. Acta Orthop Belg. 1993. 59:109–112.
13. Fahmy NRM. Unusual Monteggia lesion in children. Injury. 1980. 12:399–404.
14. Degreef I, De Smet L. Missed radial head dislocation in children associated with ulnar deformation: treatment by open reduction and ulnar osteotomy. J Orthop Trauma. 2004. 18:375–378.
15. Koslowsky TC, Mader K, Wulke AP, Gausepohl T, Pennig D. Operative treatment of chronic Monteggia lesion in younger children: A report of three cases. J Shoulder Elbow Surg. 2006. 15:119–121.
16. Kalamchi A. Monteggia fracture-dislocation in children. Late treatment in two case. J Bone and Joint Surg Am. 1986. 68:615–619.
17. Wiley JJ, Pegington J, Horwich JP. Traumatic dislocation of the radius at the elbow. J Bone Joint Surg Br. 1974. 56:501–507.
18. Boyd HB, Boals JC. The Monteggia lesion. A review of 159 cases. Clin Orthop Relat Res. 1969. 66:94–100.
19. Hui J, Sulaiman AR, Lee HC, L'am KS, Lee EH. Open reduction and annular ligament reconstruction with fascia of the forearm in chronic Monteggia lesions in children. J Pediatr Orthop. 2005. 25:501–506.
20. Bell Tawse AJS. The treatment of malunited anterior Monteggia fractures in children. J Bone Joint Surg Br. 1965. 47:718–723.
21. Gyr BM, Stevens PM, Smith JT. Chronic Monteggia fractures in children: outcome after treatment with the Bell-Tawse procedure. J Pediatr Orthop B. 2004. 13:402–406.
22. Lloyd-Roberts GC, Bucknill TM. Anterior dislocation of the radial head in children: aetiology, natural history and management. J Bone Joint Surg Br. 1977. 59:402–407.
23. Dormans JP, Rang M. The problem of Monteggia fracture-dislocations in children. Orthop Clin North Am. 1990. 21:251–256.
24. Olney BW, Menelaus MB. Monteggia and equivalent lesions in childhood. J Pediatr Orthop. 1989. 9:219–223.
25. David-West KS, Wilson NI, Sherlock DA, Bennet GC. Missed Monteggia injuries. Injury, Int J Care Injure. 2005. 36:1206–1209.
26. Letts M, Locht R, Wiens J. Monteggia fracture-dislocation in children. J Bone Joint Surg Br. 1985. 67:724–727.
XML Download