Chronic Radial Head Dislocation in Children, Part 1: Pathologic Changes Preventing Stable Reduction and Surgical Correction

Kim, Hui Taek; Conjares, Jesse Noel V.; Suh, Jeung Tak; Yoo, Chong Il

doi:10.1097/01241398-200209000-00004

Cited by 76 publications

(78 citation statements)

References 29 publications

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“…Unreduced dislocation of the radial head for more than 4 weeks is considered to be chronic. The factors like interval between injury and treatment, patient's age and the amount of joint incongruity plays an important role [15] . Hirayama et al [16] and Stoll et al [17] reported that reconstruction could be successfully achieved in children up to the age of 10 years and at least four years after the injury.…”

Section: Resultsmentioning

confidence: 99%

Monteggia fracture dislocation: A study on the functional outcome of surgical treatment in patients attending Osmania General Hospital, Hyderabad, Telangana, India

Korani¹

2018

Int. J. Orthop. Sci.

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The aim of this study was to assess the effectiveness of surgical treatment by open reduction and internal fixation of Monteggia fracture dislocation and evaluate the union of fracture, complications encountered during treatment and assess the functional outcome of the results. The study comprised of 18 cases including adults and children, admitted in orthopaedic wards of Osmania General Hospital, Hyderabad, Telangana, India. The patients age range was 7 ->50 yrs. The incidence of injury was of Type I in 77.77% and Type II 22.23% cases, no cases of type III and Type IV fracture dislocation and children had only Type I fracture dislocation. The acute cases were treated surgically, using medullary nails, plate fixation and lag screw as implants. Open reduction was done in 77.73% and closed reduction in 22.22% cases. Regular follow up was done between 4 to 8 weeks duration and all fractures healed satisfactorily. The functional outcome of the results were evaluated using Anderson's scoring system and graded as excellent / good, fair and poor depending on the range of motion in flexion-extension and pronationsupination. Our study results were excellent/good in 46.15% cases, fair and satisfactory in 7.69% and bad results in 46.15% patients. The functional outcome of surgical treatment in fresh cases of our study was good in 62.50% cases, fair in 12.5% and bad results in 25% patients. Out 3 cases of conservative treatment, 1 case showed good results and 2 cases bad results were observed in n = 2 (67%) cases. In this study, 2 old cases treated surgically showed bad results.

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Section: Resultsmentioning

confidence: 99%

Monteggia fracture dislocation: A study on the functional outcome of surgical treatment in patients attending Osmania General Hospital, Hyderabad, Telangana, India

Korani¹

2018

Int. J. Orthop. Sci.

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“…There are well-recognised clinical and radiological criteria which have to be assessed before considering surgery. 17 The morphology of the radial head and the capitellum is of great importance since it is not correctable and has a major effect on the outcome. 3,7,8,16,17 The joint surface of the dislocated head in long-standing post-traumatic cases and congenital dislocations is convex because of the lack of capitellar counter pressure.…”

Section: Discussionmentioning

confidence: 99%

Open reduction, ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius

Hasler

Laer

Hell

2005

The Journal of Bone and Joint Surgery. British volume

105

103

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We reviewed 15 patients, nine girls and six boys, with chronic anterior dislocation of the radial head which was treated by ulnar osteotomy, external fixation and open reconstruction of the elbow joint but without repair of the annular ligament. Their mean age was 9.5 years (5 to 15) and the mean interval between the injury and reconstruction was 22 months (2 months to 7 years).All radial heads remained reduced at a mean follow-up of 20 months (6 months to 5 years). Normal ranges of movement for flexion, extension, pronation and supination were unchanged in 96.1% (49/51) and worse in 3.9% (2/51). Limited ranges of movement were improved in 77.8% (7/9), unchanged in 11% (1/9) and further decreased in 11% (1/9).There were two superficial pin-track infections and two cases of delayed union but with no serious complications. Reconstruction of the radiocapitellar joint is easier using external fixation since accurate correction of the ulna can be determined empirically and active functional exercises started immediately. Only patients with a radial head of normal shape were selected for treatment by this method.The outcome of surgical reconstruction of long-standing dislocation of the radial head is uncertain. Further subluxation and dislocation may occur in more than 20% of patients.

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“…3 Although in the short term persistent dislocations do well, the natural history of chronic Monteggia lesions is not benign and is associated with restricted forearm rotation and elbow flexion, radial head overgrowth, progressive valgus deformity, pain, instability, tardy nerve palsies and potential degenerative arthritis. [4][5][6][7][8] Treatment of chronic radial head dislocation is much more complicated and challenging then the management of an acute Monteggia lesion.…”

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confidence: 99%

Surgical treatment in children missed Monteggia lesions at Bhuj, Kutch, Gujarat: a retrospective study

Chauhan¹

2016

Int J Res Orthop

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Background: The treatment of an unrecognized Monteggia lesion continues to pose a therapeutic challenge, as evidenced by the variety of surgical techniques described. Moreover, there are high complication and redislocation rates following surgery. This report concerns a surgical technique to reduce a chronic dislocation of the radial head utilizing an ulnar osteotomy and internal fixation.Methods: Present study was performed at department of orthopedics, Gujarat Adani institute of medical science, Bhuj, Kutch, Gujarat. Ethical clearance was taken from the institutional ethics board and informed consent was obtained from all the participants. Between July 2015 and September 2016 six children presented in a traumatic context with chronic dislocation of the radial head and malunion of the ulna. Patient mean age was 6.5 (range 4–8) years, and the mean interval between injury and surgical procedure was 17 (range 1–49) months. Surgery consisted of an ulnar osteotomy with angulation and lengthening, bone grafting at the osteotomy site, and internal fixation. Open reduction of the radial head, repair or reconstruction of the annular ligament or temporary fixation of the radial head with a transarticular wire was not undertaken. Cast immobilization with the forearm in neutral rotation was maintained for 4-6 weeks.Results: There was one case of nonunion. At an average follow-up of 3 (range 1.5–4.4) years, all patients had regained painless function of the forearm, good range of elbow and forearm motion, and maintenance of the radial head reduction. Conclusions: Both angulation and elongation of the ulna are required to allow for reduction of the radial head. We do not see any indication for procedures directed at the radio-capitellar joint.

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Chronic Radial Head Dislocation in Children, Part 1: Pathologic Changes Preventing Stable Reduction and Surgical Correction

Cited by 76 publications

References 29 publications

Monteggia fracture dislocation: A study on the functional outcome of surgical treatment in patients attending Osmania General Hospital, Hyderabad, Telangana, India

Monteggia fracture dislocation: A study on the functional outcome of surgical treatment in patients attending Osmania General Hospital, Hyderabad, Telangana, India

Open reduction, ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius

Surgical treatment in children missed Monteggia lesions at Bhuj, Kutch, Gujarat: a retrospective study

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