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

Park, Hoon; Park, Kwang Won; Park, Kun-Bo; Kim, Hyun Woo; Eom, Nam Kyu; Lee, Dong Hoon

doi:10.3349/ymj.2017.58.4.829

Cited by 28 publications

(42 citation statements)

References 46 publications

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“…[15] Osteotomy of the ulna will be required to repair Monteggia injuries, thus bringing huge trauma to those patients. [16] However, early diagnosis and adequate treatment of Monteggia fractures result in excellent outcomes, and allow for conservative management in most cases, without complex surgical procedures involving osteotomies of the ulna, or repair or reconstruction of the annular ligament. On the other hand, some pathologic changes may develop to prevent reduction of the radial head when the diagnosis is delayed.…”

Section: Discussionmentioning

confidence: 99%

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%

Comparison of treatment methods for pediatric Monteggia fracture

He¹,

Hao

Shao³

2019

Medicine

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“…The baseline characteristics of the enrolled patients are shown in Table 1. There were 10 boys and 2 girls, with a mean age of 6.8 AE 2.9 years (range, [3][4][5][6][7][8][9][10][11][12]. Eight children had lesions in the right arm.…”

Section: Resultsmentioning

confidence: 99%

“…An unreduced dislocation of the radiocapitellar joint that is still present 4 weeks after injury is defined as a chronic Monteggia lesion. 3 Furthermore, the frequency of complications, such as progressive valgus deformity of the elbow, limitation of forearm rotation, and pain with strenuous activity, is high, 4 but the optimal treatment measures for the same remain debatable. 5 Therefore, it is important to determine whether associated nerve injuries are present, particularly those involving the radial nerve (RN) and posterior interosseous nerve (PIN).…”

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confidence: 99%

Ultrasonographic evaluation of radial nerve injuries associated with pediatric chronic monteggia lesions

Liu

Sui

et al. 2018

Muscle and Nerve

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Introduction: To determine the ultrasonographic evaluation of the radial nerve (RN) before correction of chronic pediatric Monteggia lesions in patients with suspected nerve injury. Methods: Twelve consecutive children with Monteggia lesions were investigated. The cross-sectional area (CSA) of the nerve and the nerve-to-skin (N-S) distance were determined by ultrasonography at 3 levels: 5 cm proximal to the humeroradial joint (L_prox), a horizontal line through the humeroradial joint (L_mid), and 2.5 cm distal to the humeroradial joint (L_dist). Results: The CSA was greater on the injured side than on the unaffected side at L_prox and at L_mid (P < 0.01), but no difference was noted for posterior interosseous nerve (PIN) at L_dist (P = 0.445). The N-S values were greater on the unaffected side than on the injured side (P < 0.01), but there was no difference at L_dist in superficial RN and PIN. Discussion: Ultrasonography allowed the preoperative assessment of the severity of RN injuries in chronic pediatric Monteggia lesions.Muscle Nerve 59: [326][327][328][329][330] 2019 Abbreviations: CSA, cross-sectional area; D dist1 , the depth from the SRN to the skin at point L_dist; D dist2 , the depth from the PIN to the skin at L_dist; D mid1 , the depth from the SRN to the skin at L_mid; D mid2 , the depth from the PIN to the skin at L_mid; D prox , the depth from the RN to the skin at L_prox; L_dist, 2.5 cm distal to the humeroradial joint; L_mid, horizontal line through the humeroradial joint; L_prox, 5 cm proximal to the humeroradial joint; N-S, nerve-to-skin; PIN, posterior interosseous nerve; RN, radial nerve; SRN, superficial radial nerve;; US, ultrasound

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“…On the one hand, it might be not sufficient to restore the alignment of the radiocapitellar joint simply by ulnar osteotomy because a dislocated or torn annular ligament can form meniscoid scar tissue, although several cases have been treated successfully. 14 Therefore, we initially preferred to excise the tissue that might have prevented the reduction. On the other hand, because of the chronicity of the injury, a congruent proximal radiocapitellar reduction might be difficult to perform.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, there were also several reports about successful closed reduction of the radial head by ulnar osteotomy in missed Monteggia fractures. 14 Thus, it is generally accepted that correction of ulnar malalignment and relief of the tension in the interosseous membrane are the most important factors for achieving and maintaining reduction of the radial head. 18 Thus, the correction of malalignment with ulnar osteotomy is the key to a good surgical result.…”

Section: Discussionmentioning

confidence: 99%

Treatment of missed Monteggia fracture with intact annular ligament after an interval of 9 years: a case report and literature review

Zhou

2020

J Int Med Res

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Objective Missed Monteggia fractures are commonly observed among children. Both the interval from the injury to surgery and the patient’s age at operation are thought to be correlated directly with the success of the surgery and prognosis. The aim of the present work was to report one interesting adult case of a missed Monteggia fracture with an intact annular ligament 9 years after injury and the outcomes at a 7-year follow-up. Case description One missed lesion with a 9-year delay for surgery occurred in a skeletally mature individual, and it was treated by open reduction and ulnar angulation and elongation osteotomy. The annular ligament was interpositioned intact in the radiocapitellar joint, and therefore, instead of the annular ligament reconstruction (ALR), relocation was performed. Results After one revision surgery for the complication of nonunion, good radiographic and functional outcomes were eventually sustained at the 7-year follow up. Conclusion Good radiographic and functional outcomes can be expected in adult patients in whom the annular ligament is intact and interpositioned, and this was treated by open reduction and ulnar osteotomy 9 years after the initial injury in our patient.

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

Cited by 28 publications

References 46 publications

Comparison of treatment methods for pediatric Monteggia fracture

Comparison of treatment methods for pediatric Monteggia fracture

Ultrasonographic evaluation of radial nerve injuries associated with pediatric chronic monteggia lesions

Treatment of missed Monteggia fracture with intact annular ligament after an interval of 9 years: a case report and literature review

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