Chronic Posttraumatic Anterior Dislocation of the Radial Head in Children

Wang, Matthew N.; Chang, Wei‐Ning

doi:10.1097/01.bot.0000189881.75421.92

Cited by 95 publications

(53 citation statements)

References 36 publications

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“…So we do not have a homogeneous group of patients, and the number of the patients in each group of our cohort is insufficiently large to be considered significant from the statistical point of view. In the orthopaedic literature, several reports have included more than ten cases [ [10,20,23,[24][25][26][27][28] ], but only Hory and Nakamura more than 15 and few of them provided statistical evidence to support their indication [18,21].…”

Section: Discussionmentioning

confidence: 99%

Outcomes after surgical treatment of missed Monteggia fractures in children

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Outcomes after surgical treatment of missed Monteggia fractures in children

et al. 2015

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“…Some authors have done ligament reconstruction in every case whereas others have reported its use only when there is residual instability of the radial head after ulna osteotomy 78. Annular ligament reconstruction is not without complications and hence its use in every case may not be required 49–13…”

Section: Introductionmentioning

confidence: 99%

Missed Monteggia fracture in children: Is annular ligament reconstruction always required?

Bhaskar

2009

Indian J Orthop

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Background:Chronic (neglected) radiocapitellar joint dislocation is one of the feared complications of Monteggia fractures especially when associated with subtle fracture of the ulna bone. Many treatment strategies have been described to manage chronic Monteggia fracture and the need for annular ligament reconstruction is not always clear. The purpose of this study is to highlight the management of missed Monteggia fracture with particular emphasis on utility of annular ligament reconstruction by comparing the two groups of patients.Materials and Methods:In a prospective study 12 patients with mean age of 7.4 years, who presented with neglected Monteggia fractures, were studied. All children underwent open reduction of the radiocapitellar joint. Five children (Group A) were treated with angulation-distraction osteotomy of ulna and annular ligament reconstruction and six cases (Group B) required only angulation-distraction osteotomy of ulna without ligament reconstruction. In one case an open reduction of the radiocapitellar joint was sufficient to reduce the radial head and this was included in Group B. The gap between injury and presentation was from 3 months to 18 months (mean 9 months). Ten patients were classified as Bado I, and one each as Bado II and III respectively. We used the Kim's criteria to score our results.Result:The mean follow-up period was 22 months. All ulna osteotomies healed uneventfully. The mean loss of pronation was 15 degree in Group A and 10 degree in Group B. Elbow flexion improved from the preoperative range and no child complained of pain, deformity and restriction of activity. The elbow score was excellent in 10 cases, and good in two cases.Conclusion:Distraction-angulation osteotomy of the ulna suffices in most cases of missed monteggia fracture and the need for annular ligament reconstruction is based on intraoperative findings of radial head instability.

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“…However, in some previous studies, ulnar osteotomy for the treatment of missed Monteggia fracture has been performed at proximal area not original fracture site of the ulnar, which helped maintain the integrity of the interosseous membrane 123233. Although ulnar osteotomy is not a difficult procedure, there are several complications related to ulnar osteotomy, including delayed union, nonunion, fixation failure, and negative cosmetic problems 9143435. Therefore, we think that open reduction of radiocapitellar joint may be considered as first step if the ulnar length and alignment is not deformed severely.…”

Section: Discussionmentioning

confidence: 99%

“…5). The osteotomy site was the area of maximum deformity or at the proximal third of ulna if there was no apparent deformity 1214. After osteotomy, the osteotomy site was angulated to correct the deformity, and the radial head was easily reduced by manipulation.…”

Section: Methodsmentioning

confidence: 99%

“…Surgical treatment is usually recommended for patients with pain or limited functionality with loss of elbow motion, in whom the concave morphology of the radial head is preserved 5. For this, there are various surgical treatment options, including open reduction of the radial head and ulnar osteotomy with or without annular ligament reconstruction (ALR),26789101112131415 closed reduction by ulnar correction using single-stage osteotomy,16171819 or gradual distraction lengthening using an external fixator 202122. Although many studies have reported various techniques, there is no established standard treatment protocol for missed Monteggia fracture.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Open Reduction on Surgical Strategies for Missed Monteggia Fracture in Children

Park

et al. 2017

Yonsei Med J

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PurposeThe aims of this study were to review our cases of missed Monteggia fracture treated by open reduction of the radial head with or without ulnar osteotomy and to investigate the indications for open reduction alone in surgical treatment of missed Monteggia fracture.Materials and MethodsWe retrospectively reviewed 22 patients who presented with missed Monteggia fracture. The patients' mean age at the time of surgery was 7.6 years. The mean interval from injury to surgery was 16.1 months. The surgical procedure consisted of open reduction of the radiocapitellar joint followed by ulnar osteotomy without reconstruction of the annular ligament. The mean period of follow-up was 3.8 years. Radiographic assessment was performed for the maximum ulnar bow (MUB) and the location of the MUB. Clinical results were evaluated with the Mayo Elbow Performance Index and Kim's scores.ResultsFive patients underwent open reduction alone, and 17 patients underwent open reduction and ulnar osteotomy. When the MUB was less than 4 mm and the location of the MUB was in the distal 40% of the ulna, we could achieve reduction of the radial head without ulnar osteotomy. The radial head was maintained in a completely reduced position in 21 patients and was dislocated in one patient at final follow-up.ConclusionOpen reduction alone can be an attractive surgical option in select patients with missed Monteggia fracture with minimal bowing of the distal ulna. However, ulnar osteotomy should be considered in patients with a definite ulnar deformity.

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Chronic Posttraumatic Anterior Dislocation of the Radial Head in Children

Abstract: This surgical procedure provides a high success rate with a low level of complications for chronic radial head dislocations in children.

Cited by 95 publications

References 36 publications

Outcomes after surgical treatment of missed Monteggia fractures in children

Outcomes after surgical treatment of missed Monteggia fractures in children

Missed Monteggia fracture in children: Is annular ligament reconstruction always required?

Impact of Open Reduction on Surgical Strategies for Missed Monteggia Fracture in Children

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