Monteggia lesion and its equivalents in children

Cepelik, Martin; Pešl, T; Hendrych, Jan; Havránek, P

doi:10.1302/1863-2548.13.190131

Cited by 17 publications

(19 citation statements)

References 22 publications

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“…Sometimes a small fleck of metaphyseal bone around the proximal radial diaphysis can be seen, indicating SH II fracture or transverse fracture through the neck of the radius. In a study by Čepelík et al [ 19 ], the proximal radial physeal separation of SH type II was the most common among equivalents in their study. ElKhouly et al [ 13 ] reported a variant associated with SH type II injury and anterior radial head dislocation in a 10-year-old boy and proposed that Monteggia equivalent lesions with an SH fracture of the proximal radius are an unstable fracture configuration.…”

Section: Discussionmentioning

confidence: 95%

“…If inadequate treatment is applied, equivalent lesions may lead to poor clinical and radiographic results[ 2 ]. Čepelík et al [ 19 ] warned of worse results in the treatment of Monteggia equivalents, and operative treatment was indicated in most patients in this group[ 19 ]. As reported by Olney and Menelaus, 10 of the 14 (71.4%) patients with Monteggia type I equivalent lesions involving the proximal radius required surgery[ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Monteggia type-I equivalent fracture in a fourteen-month-old child: A case report

Li¹,

Zhou²,

Li³

et al. 2021

WJCC

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BACKGROUND Monteggia and equivalent lesions are relatively rare but result in severe injuries in childhood, typically affecting children between 4 and 10 years old. The diagnosis and treatment of an equivalent Monteggia lesion is more complicated than those of a typical Monteggia fracture. This type of lesion may be challenging and may lead to serious complications if not treated properly. Pediatric Monteggia equivalent type I lesions have been reported in a few reports, all of which the patients were all over 4 years old. CASE SUMMARY A 14-mo-old boy was referred to our clinic after falling from his bed 10 d prior. With regard to the clinical examination, an obvious swollen and angular deformity was noted on his right forearm. Plain radiographs and reconstructed computed tomography scans showed a Monteggia type I fracture and dislocation. Magnetic resonance imaging (MRI) confirmed a type I Monteggia equivalent lesion consisting of ulnar fracture and Salter-Harris type I injury in the proximal radius. The radial head was still in the joint, and only the radial metaphysis was displaced anteriorly. Open reduction and pinning of both displaced radial and ulnar fractures achieved an excellent result with full function. CONCLUSION We recommend MRI examination or arthrography during reduction, especially if the secondary ossification center has not appeared.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Monteggia type-I equivalent fracture in a fourteen-month-old child: A case report

Li¹,

Zhou²,

Li³

et al. 2021

WJCC

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“…Se presente, e observada a presença de fratura na ulna, deve ser considerado o quadro clássico de Monteggia. Nosso paciente apresentava luxação anterior da cabeça do rádio com deformida-de da ulna com ápice anterior, o que configura um quadro de Monteggia do tipo 1, tipo mais comum nos pacientes pediátricos (5)(6)(7)(8) .…”

Section: Discussionunclassified

Osteotomia da ulna para correção cirúrgica de fratura de Monteggia negligenciada em criança com deformidade plástica da ulna. Relato de caso / Ulna osteotomy for surgical correction of neglected Monteggia fracture in a child with ulna bowing. Case report

Garotti

Carrenho

Netto

2021

Arq Med Hosp Fac Cienc Med Santa Casa São Paulo

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Introdução: A luxação da cabeça do rádio com deformidade plástica da ulna, quando combinadas, configuram uma condição rara, e frequentemente não diagnosticada na urgência. Objetivo: Relatar um caso de fratura de Monteggia negligenciada em criança com defomidade plástica da ulna, tratada cirurgicamente com redução e fixação da cabeça dorádio, sem reconstrução do ligamento anular, e osteotomia da ulna. Relato do Caso: Paciente de 6 anos de idade, sexo masculino, vítima de queda ao solo com a mão espalmada, deu entrada em Unidade de Pronto Atendimento com queixa de dor no cotovelo direito. Paciente foi submetido à exames de imagem radiográficos do cotovelo interpretados peloexaminador como sem alterações. Duas semanas após, o paciente retornou mantendo dor, e foram solicitados exames de radiografia do antebraço, que evidenciaram presença de deformidade plástica da ulna associada à luxação da cabeça do rádio. Como tratamento, optou-se pela redução aberta e fixação da cabeça do rádio com fios metálicos, associado aosteotomia de flexão da ulna fixada com fio de Kirschnner. Evoluiu no pós operatório com consolidação da osteotomia, manutenção da redução da cabeça do rádio, e recuperação do arco de movimento total do cotovelo e antebraço. Conclusão: Pacientes pediátricos que se apresentam com dor no cotovelo, em decorrência de queda com a mão espalmada, devem ser minuciosamente avaliados quanto à possibilidade de deformidade plástica da ulna associada à luxação da cabeça do rádio. A osteotomia na ulna com fixação da cabeça do rádio, sem reconstrução do ligamento anular, trouxe bom resultado no tratamento de fratura de Monteggia negligenciada em criança com defomidade plástica da ulna. Palavras chave: Fratura de Monteggia, Ulna/deformidades, Fraturas da ulna, Osteotomia, Trauma, Criança, Pediatria Abstract Introduction: Dislocation of the radial head with ulna bowing, when combined, constitutes a rare condition, and often missed diagnosed. Objective: Report a case of neglected Monteggia fracture in a child with ulna bowing, treated surgically with reduction and fixation of the radial head, without reconstruction of the annular ligament, and osteotomy of the ulna. Case Report: A 6-year-old male patient, victim of falling to the ground, was admitted to the Emergency Department with complaints of pain in his right elbow. The patient was submitted to radiographic exams of the elbow, interpreted by the physician as normal. Two weeks later, the patient returned with pain, and radiographic exams of the forearm showed the presence of ulna bowing associated with dislocation of the radial head. As a treatment, we opted for open reduction and fixation of the radial head with metallic wires, associated with flexion osteotomy of the ulna. It evolved in the postoperative period with consolidation of the osteotomy, maintenance of the reduction of the radial head, and recovery of the total range of motion of the elbow and forearm. Conclusion: Pediatric patients who present with pain in the elbow, due to a fall, should be thoroughly evaluated for the possibility of ulna bowing associated with dislocation of the radial head. Ulna osteotomy with fixation of the radial head, without reconstruction of the annular ligament, brought good results in the treatment of neglected Monteggia fracture in a child with ulna bowing. Keywords: Monteggia fracture, Ulna/deformities, Ulna fractures, Osteotomy, Trauma, Child, Pediatrics

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“…The discussion has never stopped over 'the equivalent' as to its presentation, injury combination, mechanism, diagnosis, and management in the past several decades when a few sporadic case reports demonstrated some of the unclassifiable 'equivalent'. [8][9][10][11][12][13][14][15][16][17][18][19][20] A most recent contribution towards the definition has been made by Čepelík et al 21 and his group in their study of 111 cases. They defined it as an ulnar fracture at any level combined with 'displaced' (with undisplaced or minimal displaced ones were not included) proximal radial fracture, which embraced Olney criteria and was consistent with Bado Ia-Ic.…”

Section: Definitionmentioning

confidence: 99%

Monteggia equivalent lesion in children: a narrative review

et al. 2021

World Jnl Ped Surgery

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BackgroundMonteggia equivalent lesion represents a group of injury or combined injury patterns that resemble the Monteggia lesion in its presentations and mechanisms. Unlike Monteggia lesions, the equivalent ones, which share vague definitions and mostly occur as sporadic single case reports in the literature, have not been thoroughly reviewed since Bado first proposed the term, especially in the pediatric population. The objective of this review was to elucidate the definition by elaborating on its clinical styles and thus analyzing the mechanism, diagnosis, and management through related literature.Data sourcesBased on the terms of ‘Monteggia equivalent’, ‘radial neck fracture’ and ‘pediatric’, all of the related literature was searched on the PubMed and Google Scholar search engine.ResultsThe advance of the definitions for pediatric Monteggia equivalent lesion (PMEL) was reviewed. The functional roles of the ulnar and the related mechanism theories in this injury were analyzed. The status of the radiocapitellar joint in this injury was emphasized. According to the previous statements, a new classification model was proposed and proper diagnosis and treatment approaches were suggested.ConclusionsPMEL should be defined as an ulnar fracture at any level combined with a proximal radial fracture. According to the status of the radiocapitellar joint, it could be divided into three groups. The occult ulnar bowing and delayed radial head dislocation should be a serious concern of orthopedists. Surgical need is usually warranted. Maintaining the ulnar length and securing the radiocapitellar joint are highly recommended.

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Monteggia lesion and its equivalents in children

Cited by 17 publications

References 22 publications

Monteggia type-I equivalent fracture in a fourteen-month-old child: A case report

Monteggia type-I equivalent fracture in a fourteen-month-old child: A case report

Osteotomia da ulna para correção cirúrgica de fratura de Monteggia negligenciada em criança com deformidade plástica da ulna. Relato de caso / Ulna osteotomy for surgical correction of neglected Monteggia fracture in a child with ulna bowing. Case report

Monteggia equivalent lesion in children: a narrative review

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