Neglected Monteggia fracture: a review

Zhang, Rui; Wang, Xiaoyu; Xu, Jia; Kang, Qinglin; Hamdy, Reggie C.

doi:10.1530/eor-21-0087

Cited by 9 publications

(2 citation statements)

References 75 publications

(250 reference statements)

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“…The surgical treatment attempts to cure the ulnar angular deformity, stabilize the radial head, and restore appropriate radiocapitellar joint alignment. Despite the fact that multiple studies have reported diverse treatments for neglected Monteggia fractures, which vary from position to conduct osteotomy, fixation alternatives, and annular ligament restoration, there is still no standard procedure or guidelines (7).…”

Section: Discussionmentioning

confidence: 99%

A Pediatric Monteggia Fracture Unattended for Five Years

Altowairqi,

Mofareh Alsubaie,

Muidh Almalki

2023

JOHS

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Background: The Monteggia fracture classically involves a proximal third ulna fracture that is accompanied by radial head subluxation or dislocation. Monteggia fractures are highly uncommon, as they account for just 1% of pediatric forearm fractures. However, Monteggia fractures continue to be a concern for pediatric orthopedic surgeons due to the difficulties in diagnosing and treating missing radial head dislocations and late instability. Case: We report the case of a 14-year-old boy who suffered from a neglected Monteggia fracture that was missed for five long years. The patient reported to the clinic with limited range of motion and elbow pain during activities. No neurological or other significant complications were observed. X-ray and Computed Tomography (CT) scan findings confirmed the diagnosis of a neglected Monteggia fracture. The patient was managed through rehabilitation involving physiotherapy sessions since the parents refused surgical intervention. Conclusion: Our case is unique to the present since it is the only case, to the best of our knowledge, with such an increased time duration of neglected Monteggia fracture, and additionally, it was managed with rehabilitation only. However, further research is necessary to study more alternative management options for the management of neglected Monteggia fractures.

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Section: Discussionmentioning

confidence: 99%

A Pediatric Monteggia Fracture Unattended for Five Years

Altowairqi,

Mofareh Alsubaie,

Muidh Almalki

2023

JOHS

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“…Monteggia fracture was first described by Giovanni Battista Monteggia in 1814, and reported two cases of ulnar shaft fractures accompanied by anterior dislocation of the radial head [1,2] . With further understanding, ulnar fracture, traumatic bowing associated with radiocapitellar and proximal radio dislocation, are now considered as a manifestation of Monteggia fracture [3,4] . Recent studies suggest that the dividing line for missed Monteggia fracture(MMF) should be over 4 weeks after injury, as malunion of the distal radius can had already occurred [1,5] .…”

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confidence: 99%

Radiocapitellar joint plasty for missed Monteggia fracture with radial head deformity in children: a Retrospective Study

Li,

Tian,

Jing

2023

Preprint

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objectives The objective of our retrospective study was to review the clinical and radiological outcome of patients who were treated with radiocapitellar joint plasty. Methods This retrospective study evaluated 10 children with missed Monteggia fracture (MMF). The average time from injury to operation was 20 months. The average age of children who underwent the operation was 10.5 years old. There are 6 flat and 4 domed radial head. There are 7 type I and 3 type III according to the bado classification. All children with MMF were treated by open radial head reduction with radiocapitellar joint plasty and ulnar osteotomy with or without annular ligament (ALR). Results All patients successfully completed the operation. The average union time 4.9 ± 2.6 months. The average osteotomy angle to reduce the radial head was 15.7 ± 3.5°, and the average lengthening of the ulna was 6.1 ± 3.2 mm. At last follow-up, the average pre-operative flexion range of motion was110.5 ± 9.1° and that in the post-operative was 138.8 ± 15.1°(p < 0.05). The average pre-operative extension range of motion was10.1 ± 3.2° and that in the post-operative was 5.5 ± 3.3°(p < .05). The average pre-operative pronation range of motion was78.8 ± 8.7° and that in the post-operative was81.1 ± 5.6°(p > 0.05). The average pre-operative supination range of motion was 68.3 ± 9.7° and that in the post-operative was 80.1 ± 7.8°(p < 0.05). The pre-operative kim score was 66.5 ± 10.9 and that in the post-operative was 88.1 ± 12.6 (p < 0.05). The radial head was maintained in a completely reduced position in 9 of the10 patients and 1 subluxated. Osteoarthritic changes of the radiocapitellar joint were observed in 2 patients which is domed radial head. Conclusions Surgical approach for MMF involves radiocapitellar joint plasty is significantly effective. It has favorable functional outcomes while ensuring the maintenance of radial head reduction.

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