Evaluation of Outcome of Corrective Ulnar Osteotomy with Bone Grafting and Annular Ligament Reconstruction in Neglected Monteggia Fracture Dislocation in Children

Datta, Tanmay; Chatterjee, Nandini; Pal, Ananda Kisor; Das, Sunil K.

doi:10.7860/jcdr/2014/9891.4409

Cited by 17 publications

(48 citation statements)

References 16 publications

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“…There are several surgical procedures available for the treatment of chronic radial head dislocation, including osteotomy of the ulna [ 19 – 22 ] with or without annular ligament reconstruction [ 16 , 23 – 25 ]. Annular ligament reconstruction according to the Bell Tawse procedure is one popular technique, in which a slip of the triceps tendon is looped around the radial neck to stabilize the radial head.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical study of isolated radial head dislocation

Hayami

Omokawa

Iida

et al. 2017

BMC Musculoskelet Disord

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BackgroundIsolated radial head dislocation is a rare injury with an unclear pathomechanism, and the treatment is controversial. The purpose of the present study was to investigate the biomechanical contributions of the annular ligament, quadrate ligament, interosseous membrane, and annular ligament reconstructions to proximal radioulnar joint stability.MethodsFive fresh frozen cadaveric upper extremities were amputated above the elbow and solidly fixed on a customized jig. Radial head dislocation was reproduced by sequential sectioning of ligamentous structures and passive mobility testing. Radial head displacement during mobility testing was measured with an electromagnetic tracking device in three forearm rotation positions. The data were compared among different sectioning stages and between two types of simulated ligamentous reconstruction.ResultsLateral displacement of the radial head significantly increased in the neutral forearm rotation after annular ligament sectioning (46 ± 10%, p < 0.05). After quadrate ligament sectioning, we found significant posterior (67 ± 36%, p < 0.05) and lateral (74 ± 24%, p < 0.01) displacement in neutral forearm rotation and pronation. Significant radial head displacement was found in all directions and in all forearm positions after sequential sectioning of the proximal half of the interosseous membrane. Anatomical annular ligament reconstruction stabilized the proximal radioulnar joint except for anterior laxity in neutral forearm rotation (15 ± 6%, p < 0.05). The radial head with Bell Tawse procedure was significantly displaced in all directions.ConclusionThe direction of radial head instability varied depending on the degree of soft tissue sectioning and specific forearm rotation. Anterior radial head dislocation may involve more severe ligament damage than other types of dislocation. Anatomical annular ligament reconstruction provided multidirectional radial head stability.

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Section: Discussionmentioning

confidence: 99%

Biomechanical study of isolated radial head dislocation

Hayami

Omokawa

Iida

et al. 2017

BMC Musculoskelet Disord

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“…Neglected or missed Monteggia fractures are described as cases presenting 4 weeks after the initial trauma [5].…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of chronic Monteggia is challenging. There are various surgical techniques, described in the literature, as ulnar osteotomy, the open reduction of the radial head, annular ligament repair or reconstruction, bone grafting, ulna lengthening, or a combination of these [5] , [6] , [8] , [9] .…”

Section: Introductionmentioning

confidence: 99%

Posterior interosseous nerve palsy associated with neglected pediatric Monteggia fracture-dislocation: A case report

Demіrel

Sağlam

Tunalı

2016

International Journal of Surgery Case Reports

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HighlightsThe main goal of the treatment is the anatomical reduction of the ulna fracture and the radial head dislocation in acute and chronic Monteggia cases.The most commonly preferred technique is open reduction with ulnar osteotomy.The radiocapitellar joint is very sensitive to ulna length.To decide whether to repair or reconstruct the annular ligament remains controversial.Anatomic and stable restoration of radiocapitellar joint by correcting ulna deformity may be performed.

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“…15,20,28,30,40,41 Redislocations may occur more frequently if a patient only had an ulna osteotomy compared to patients that had an ulna osteotomy and a reconstruction of the annular ligament. 5,6,12 ALR has been associated with postoperative loss of pronation, 5,26,28,30,[42][43][44] especially if the ALR is not properly tensioned. In a study performed by Rodgers et al, 2/6 ALR patients developed an hourglass deformation of the radial neck, which may occur if the ligament has been reconstructed with too much tension.…”

Section: Alrmentioning

confidence: 99%

“…Most authors state that a transcapitellar K-wire may be considered if persisting instability is suspected after completing ulna osteotomy and ALR. 5,7,15,21,25,26,35,36,39,[42][43][44][47][48][49][50][51] However, we favour radioulnar K-wire fixation, because it has the advantage that no joint surfaces are damaged. In our case series, we did not find any influence of this extra immobilisation on ROM outcome.…”

Section: Transcapitellar/radioulnar Kirschner Wiresmentioning

confidence: 99%

Surgical treatment of chronic anterior radial head dislocations in missed Monteggia lesions in children: A rationale for treatment and pearls and pitfalls of surgery

Langenberg

Beumer

Koenraadt³

et al. 2019

Shoulder & Elbow

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Introduction: The treatment of chronic radial head dislocations after Monteggia lesions in children can be challenging. This article provides a detailed description of the most frequently performed surgical technique: an ulna osteotomy followed by annular ligament reconstruction. Accordingly, we present the clinical and radiological results of 10 paediatric cases. Material and methods: All paediatric patients that had a corrective osteotomy of the ulna for a missed Monteggia lesion between 2008 and 2014 were evaluated with standard radiographs and clinical examination. A literature search was performed to identify the relevant pearls and pitfalls of surgery. Primary outcome was range of motion. Results: We included 10 patients, with a mean follow-up of 2.5 years. Postoperative range of motion generally improved 30.7. Even in a patient with obvious deformity of the radial head, range of motion improved after surgery, without residual dislocation of the radial head. Conclusion: Corrective proximal ulna osteotomy with rigid plate fixation and annular ligament reconstruction yields good results in patients with chronic radial head dislocation following a Monteggia lesion. Surgery should be considered regardless of patient age or time since trauma. Given substantial arguments in literature, we discourage surgery if a CT scan shows dome-shaped radial head dysmorphic features in work-up to surgery.

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Evaluation of Outcome of Corrective Ulnar Osteotomy with Bone Grafting and Annular Ligament Reconstruction in Neglected Monteggia Fracture Dislocation in Children

Abstract: Study showed good results with modified Hirayama osteotomy with annular ligament reconstruction using Bell Tawse procedure which is a more biological option for restoration of elbow biomechanics.

Cited by 17 publications

References 16 publications

Biomechanical study of isolated radial head dislocation

Biomechanical study of isolated radial head dislocation

Posterior interosseous nerve palsy associated with neglected pediatric Monteggia fracture-dislocation: A case report

Surgical treatment of chronic anterior radial head dislocations in missed Monteggia lesions in children: A rationale for treatment and pearls and pitfalls of surgery

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