Pediatric Monteggia Fractures

Leonidou, Andreas; Pagkalos, Joseph; Lepetsos, Panagiotis; Antonis, Konstantinos; Flieger, Ioannis; Tsiridis, Eleftherios; Leonidou, Omiros

doi:10.1097/bpo.0b013e31825611fc

Cited by 29 publications

(22 citation statements)

References 13 publications

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“…[6–10] Many studies have investigated the various options for treatment of acute Monteggia fractures, with recommendations ranging from closed reduction and casting alone, to operative fixation of acute injuries according to the fracture pattern of the ulna. [6,11,12]…”

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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“…Since Monteggia fractures in children are mostly incomplete greenstick fractures, reduction and maintenance are easy to perform. Therefore, conservative treatment can often be employed in cases with timely diagnosis [ 15 , 16 ]. However, since it was difficult to perform manual reduction owing to a double fracture of the ulna, surgery was the only treatment option available in the presented patient.…”

Section: Discussionmentioning

confidence: 99%

“…However, since it was difficult to perform manual reduction owing to a double fracture of the ulna, surgery was the only treatment option available in the presented patient. Nevertheless, to obtain good treatment results, it is important to accurately diagnose and promptly treat the condition [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

A Type III Monteggia Injury with Ipsilateral Fracture of the Distal Radius and Ulna in a Child: Case Report Followed for 21 Years

Inoue

Kubota

Marumo

2018

Case Reports in Orthopedics

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Bado type III Monteggia injuries complicated by ipsilateral forearm fractures are extremely rare. We report a case of a 6-year-old boy who sustained such an injury after falling from the top of a 3 m climbing pole. He was diagnosed with a Bado type III Monteggia fracture and forearm fractures. Manual reduction was attempted on the day of injury. However, because it was difficult to maintain the reduction of the radial head, open and percutaneous procedures were performed to reduce and fixate the fractures with Kirschner wires. The postoperative course was favorable. Twenty-one years later, the patient, now 27 years old, had no decreased range of joint motion or problems with activities of daily living. The fracture morphology observed in this case is rare, and this is the only case for which long-term follow-up has been carried out to adulthood.

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“…The management of Monteggia fractures in pediatric patients is typically dictated by the characteristics of the ulna fracture. 3–5 In children, plastic deformation or incomplete fractures are initially treated with closed reduction followed by immobilization in full supination and 110 degrees of elbow flexion for six weeks. If irreducible, then operative fixation is indicated.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, Leonidou et al reported success with closed reduction and conservative management in their series of 40 pediatric Monteggia fracture cases. 4 Operative intervention, however, may be needed if closed reduction fails.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous reduction and flexible intramedullary nailing for monteggia fracture in a skeletally mature patient

Beutel

Klifto

Chu

2014

International Journal of Surgery Case Reports

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INTRODUCTIONMonteggia lesions are defined as a fracture of the proximal ulna with an associated radial head dislocation. Management of these injuries varies depending upon the patient population, ranging from non-operative treatment with closed reduction and immobilization to surgical fixation. Percutaneous techniques of radial head reduction are often reserved for skeletally immature patients.PRESENTATION OF CASEIn this case report, a 14-year-old female presented with left elbow pain three days after a fall. Radiographs and CT images from an outside hospital revealed a displaced left radial head fracture and a non-displaced proximal olecranon fracture, consistent with a Monteggia equivalent fracture. The patient underwent percutaneous reduction and internal fixation of the radial head with a flexible intramedullary nail (Metaizeau technique), and open reduction and internal fixation of the olecranon. She developed a 25 degree left elbow flexion contracture and, five months after her index procedure, underwent arthroscopic release and removal of hardware. The radial head reduction was near anatomic and she regained full extension.DISCUSSIONThis report demonstrates that percutaneous reduction with intramedullary nailing and fixation techniques can be performed successfully in skeletally mature patients.CONCLUSIONGiven their less invasive nature, we recommend attempting percutaneous interventions in some skeletally mature individuals for fracture reduction and fixation.

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Pediatric Monteggia Fractures

Abstract: Level IV. Case series.

Cited by 29 publications

References 13 publications

Comparison of treatment methods for pediatric Monteggia fracture

Comparison of treatment methods for pediatric Monteggia fracture

A Type III Monteggia Injury with Ipsilateral Fracture of the Distal Radius and Ulna in a Child: Case Report Followed for 21 Years

Percutaneous reduction and flexible intramedullary nailing for monteggia fracture in a skeletally mature patient

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