Acute Pediatric Monteggia Fractures: A Conservative Approach to Stabilization

Foran, Ian M.; Upasani, Vidyadhar V.; Wallace, C. Doug; Britt, Elise; Bastrom, Tracey P.; Bomar, James D.; Pennock, Andrew T.

doi:10.1097/bpo.0000000000001001

Cited by 37 publications

(43 citation statements)

References 20 publications

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“…For patients with fresh Monteggia fractures, closed reduction combined with a cast is 1 of the most common treatment options, and usually results in an uneventful recovery. [5,6] But failure, or loss of reduction and missed dislocation, may require a more invasive operation. Excellent outcomes are usually anticipated following appropriate treatment of acute Monteggia injuries.…”

Section: Discussionmentioning

confidence: 99%

“…However, the complex and often unpredictable results of surgical reconstruction for chronic or missed Monteggia lesions further highlight the importance of proper initial recognition and reduction. [6–10] Many studies have investigated the various options for treatment of acute Monteggia fractures, with recommendations ranging from closed reduction and casting alone, to operative fixation of acute injuries according to the fracture pattern of the ulna. [6,11,12]…”

Section: Discussionmentioning

confidence: 99%

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Comparison of treatment methods for pediatric Monteggia fracture

He¹,

Hao

Shao³

2019

Medicine

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Various methods are applied in the treatment of fresh and neglected Monteggia fractures. The purpose of this retrospective study was to evaluate the efficacy of various treatment methods, and assess the complexity associated with missed radial head dislocation.All fracture patients were reviewed between Jan 2012 and Dec 2016. A detailed comparison was made of the treatment methods between fresh Monteggia fractures and neglected Monteggia fractures with missed diagnosis of dislocation.A preliminary analysis of clinical information from 1081 patients in our center was investigated, and 42 were included in the final analysis. The fresh group included 25 patients with an average Mayo Elbow Performance Score of 96.3 ± 2.7 and resulted in the following scores after treatment: 21 excellent, 3 good, and 1 fair. In the fresh group, 76% of patients received closed reduction. Treatment with a cast, elastic stable intramedullary nail, and the Kirschner wire stabilization with tension band wiring make up 80% of the choices for fixation treatment. No patients experienced associated vascular injuries, recurrent dislocation, or elbow dysfunction. The neglected group involved 17 patients with Mayo Elbow Performance Score of 92.1 ± 9.3 and resulted in the following scores after treatment: 10 excellent, 4 good, and 3 fair. The locking compression plate (LCP) was the most common choice for postoperative immobilization in the neglected group (88.2%). Three patients in the neglected group experienced recurrent dislocation.This retrospective analysis indicates that the treatment of neglected Monteggia fractures is more complex than that of fresh Monteggia fractures, and usually results in a worse recovery rate with a higher rate of recurrent dislocation and elbow dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of treatment methods for pediatric Monteggia fracture

He¹,

Hao

Shao³

2019

Medicine

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“…There is no consensus regarding forearm position during the immobilization period after radial head reduction. [12,13,24,30] Of the 3 positions we evaluated in our Monteggia fracture model, in the absence of ulnar angulation, only pronation was associated with significant radial head instability after annular ligament sectioning. This result indicates that physicians should avoid immobilizing the forearm in pronation after the radial head and ulnar deformities are reduced in patients with a Bado type I Monteggia fracture.…”

Section: Discussionmentioning

confidence: 98%

“…[6] Thus, when managing a Monteggia fracture, various soft tissue injuries, including proximal IOM damage, must be considered. Although many clinical [11][12][13][14] and biomechanical studies [15][16][17][18][19][20][21] have described Monteggia fractures, few have examined the correlation between the degree of soft tissue damage and radial head stability [9] ; moreover, the influence of the magnitude of ulnar angulation on elbow instability is unknown.…”

Section: Introductionmentioning

confidence: 99%

Effect of soft tissue injury and ulnar angulation on radial head instability in a Bado type I Monteggia fracture model

Hayami¹,

Omokawa

Iida³

et al. 2019

Medicine

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The effects of soft tissue damage and ulnar angulation deformity on radial head instability in Monteggia fractures are unclear. We tested the hypothesis that radial head instability correlates with the magnitude of ulnar angular deformity and the degree of proximal forearm soft tissue injury in Bado type I Monteggia fractures.We performed a biomechanical study in 6 fresh-frozen cadaveric upper extremities. Monteggia fractures were simulated by anterior ulnar angulation osteotomy and sequential sectioning of ligamentous structures. We measured radial head displacement during passive mobility testing in pronation, supination, and neutral rotation using an electromagnetic tracking device. Measurements at various ligament sectioning stages and ulnar angulation substages were statistically compared with those in the intact elbow.Radial head displacement increased with sequential ligament sectioning and increased proportionally with the degree of anterior ulnar angulation. Annular ligament sectioning resulted in a significant increase in displacement only in pronation (P < .05). When the anterior ulnar deformity was reproduced, the radial head displaced least in supination. The addition of proximal interosseous membrane sectioning significantly increased the radial head displacement in supination (P < .05), regardless of the degree of anterior ulnar angulation.Our Monteggia fracture model showed that radial head instability is influenced by the degree of soft tissue damage and ulnar angulation. Annular ligament injury combined with a minimal (5°) ulnar deformity may cause elbow instability, especially in pronation. The proximal interosseous membrane contributes to radial head stability in supination, regardless of ulnar angulation, and proximal interosseous membrane injury led to significant radial head instability in supination.

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“…The occurrence of paediatric Monteggia fractures covers between 1. Of 5% and 3% of all childhood elbow injuries[ 3 , 4 ]. Monteggia fractures remain a challenge for paediatric orthopaedic surgeons because of the difficulty involved in diagnosis and in the treatment of missed radial head dislocation and late instability.…”

Section: Introductionmentioning

confidence: 99%

Management of acute length-unstable Monteggia fractures in children: A case report

Evola¹,

Fede²,

Bonanno³

et al. 2021

WJO

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BACKGROUND Monteggia fractures are uncommon injuries in paediatric age. Treatment algorithms assert that length-unstable fractures are treated with plate fixation. In this case report, intramedullary fixation of an acute length-unstable Monteggia fracture allowed a stable reduction to be achieved, along with an appropriate ulnar length and alignment as well as radio capitellar reduction despite the fact that the orthopaedic surgeon did not use a plate for the ulnar fracture. The scope of treatment is to avoid the use of a plate that causes periosteal stripping and blood circulation disruption around the fracture. CASE SUMMARY A four-year-old girl presented at the Emergency Department following an accidental fall off a chair onto the right forearm. The X-ray highlighted a length-unstable acute Bado type 1 Monteggia fracture of the right forearm. On the same day, the patient underwent surgical treatment of the Monteggia fracture. The surgeon preferred not to use a plate to avoid a delay in fracture healing and to allow the micromotion necessary for callus formation. The operation comprised percutaneous fixation with an elastic intramedullary K-wire of the ulnar fracture and, subsequently, humeroradial joint reduction through manual manipulation. The orthopaedic surgeon assessed the stability of the radial head reduction under fluoroscopic control through flexion, extension, pronation and supination of the forearm. Healing of the fracture occurred within six weeks after surgery, as indicated by the presence of calluses on at least three cortices on standard radiographs. Dislocation/subluxation or loss of ulnar reduction was not apparent at the final X-ray examination. CONCLUSION Intramedullary fixation of unstable Monteggia fractures results in excellent outcomes, provides reliable reduction and causes fewer complications.

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Acute Pediatric Monteggia Fractures: A Conservative Approach to Stabilization

Abstract: Level IV-therapeutic studies, case series.

Cited by 37 publications

References 20 publications

Comparison of treatment methods for pediatric Monteggia fracture

Comparison of treatment methods for pediatric Monteggia fracture

Effect of soft tissue injury and ulnar angulation on radial head instability in a Bado type I Monteggia fracture model

Management of acute length-unstable Monteggia fractures in children: A case report

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