Comparison of treatment methods for pediatric Monteggia fracture

He, Jin; Hao, Yun; Shao, Jingfan

doi:10.1097/md.0000000000013942

Cited by 19 publications

(38 citation statements)

References 17 publications

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“…He et al observed similar results in acute Monteggia fracture dislocations which were managed surgically. 6 Korani in his study achieved good results in 62.5% cases which is comparable to our study. 8…”

Section: Discussionsupporting

confidence: 89%

“…He et al also noted the same trend in their study. 6 Bado classification was used to describe Monteggia fracture dislocation. Bado classification based on the direction of the radial head in fracture; in type I the head is anterior, type II is posterior, type III is lateral and in type IV there is a dislocation of the radial head associated with a fracture of both the radius and ulna.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcome of acute Monteggia fractures in children after open reduction and internal fixation of ulna

et al. 2021

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Background: Monteggia fracture dislocations are a rare but a complex injury. The fracture of the ulna associated with proximal radioulnar joint dissociation and radio capitellar dislocation. This injury comprises less than 1% of all pediatric forearm fractures and typically affects patients between 4 and 10 years of age. There are many options for treatment of these fractures. The present study was planned to assess the clinical outcome of patients treated with open reduction and internal fixation of ulna with plating.Methods: The study was conducted in department of orthopedics, government medical college and hospital, Jammu from August 2018 to January 2021. 25 patients of Monteggia fractures were managed with open reduction and internal fixation of ulna with plating. Patients were evaluated at follow-up for pain, stability and disturbance of daily and sports activities. Functional outcome was assessed using elbow performance score.Results: Mean age of study participants was 8.2 years and male children predominated our study constituting 17 patients (68%). 14 patients were Bado type 1, four patients were Bado type 2 whereas seven patients were Bado type 3. The outcome was excellent in 18 patients (72%) and no cases of failure were encountered.Conclusions: Stable anatomical fixation by open reduction and internal fixation of ulna fractures with plating, that in turns leads to the stable reduction of radial head, in the management of acute Monteggia fracture dislocations in children has a very good outcome.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Clinical outcome of acute Monteggia fractures in children after open reduction and internal fixation of ulna

et al. 2021

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“…[ 11 – 13 ] This approach is effective if the time from injury is less than 4 to 6 months, and the shape of the ulna is not compromised. [ 14 , 15 ] Besides, reduction without exposing the RCJ has also been reported using ulnar lengthening angulation osteotomy. [ 16 , 17 ] Moreover, certain authors recommend UO combined with open reduction of RHD.…”

Section: Discussionmentioning

confidence: 99%

Two-stage strategy for neglected Monteggia fracture in children

Zhao

Rai

et al. 2021

Medicine

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A neglected Monteggia fracture is defined as the fracture of the proximal ulna associated with radial head dislocation (RHD) without undergoing any treatment for 4 weeks or more after injury. One-stage operation of ulnar corrective osteotomy and open reduction of RHD might result in many complications. Therefore, a two-stage strategy, including ulnar osteotomy (UO) with or without annular ligament reconstruction (ALR), was adopted at our institute since 2010. We performed a retrospective review of 51 patients with neglected Monteggia fracture between January 2010 and January 2018. Patients with bilateral problems or concomitant injuries in the ipsilateral extremity were excluded. Radiological and clinical data were collected from Hospital Database and clinical visits. All patients were divided into 2 groups based on the status of the ALR: the UO alone (UO) group and the ALR group. There were 15 patients in the UO group and 36 patients in the ALR group. The age in the UO group (6.1 ± 2.3, year) was significantly younger than the ALR group (9.8 ± 2.8, year) ( P < .001). Concerning the duration from initial injury to surgery, there was a significant difference between the UO group (8.6 ± 3.2 months) and the ALR group (23.3 ± 12.6 months, P < .001). Concerning the preoperative elbow function, there was no significant difference between the UO group (67.6 ± 5.0) and the ALR group (66.6 ± 4.4) according to the Mayo elbow performance score (MEPS) ( P = .51). Concerning the postoperative parameters, including postoperative ROM of the joint, removal of external fixator (6.7 ± 0.8, 6.9 ± 0.9 weeks) ( P = .55), lengthening (8.9 ± 2.5, 10.3 ± 2.5 mm) ( P = .10) and MEPS (92.7 ± 2.1, 91.6 ± 2.1) ( P = .08), there was no significant difference between the UO group and ALR group. Two-stage strategy is a reasonable choice for selected patients with long-lasting RHD with ulnar deformity.

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“…Nowadays, intramedullary nailing fixation is the main method of fracture stabilization in acute, stable and unstable Monteggia injuries, while plate fixations are widely used in patients with neglected Monteggia fractures[ 15 ]. Many authors use a cut-off of fourweeks before considering a Monteggia fracture to be “neglected”.…”

Section: Discussionmentioning

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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Comparison of treatment methods for pediatric Monteggia fracture

Cited by 19 publications

References 17 publications

Clinical outcome of acute Monteggia fractures in children after open reduction and internal fixation of ulna

Clinical outcome of acute Monteggia fractures in children after open reduction and internal fixation of ulna

Two-stage strategy for neglected Monteggia fracture in children

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

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