Persistent Posterior Interosseous Nerve Palsy Associated with a Chronic Type I Monteggia Fracture-Dislocation in a Child: A Case Report and Review of the Literature

Ruchelsman, David E.; Pasqualetto, Michele; Price, Andrew E.; Grossman, John A. I.

doi:10.1007/s11552-008-9152-9

Cited by 17 publications

(12 citation statements)

References 45 publications

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“…If PIN injury is complete and irreversible, tendon transfer can be performed to restore the functions of the wrist, finger, and thumb. [16] In the current patient, surgery released the compression of the PIN, resulting in complete functional recovery at follow-up.…”

Section: Discussionmentioning

confidence: 91%

“…[15] Following the anterior dislocation of the radial head, the PINs can be easily injured by compression and excessive traction. [16] Patients who experience PIN injury at the time of Monteggia fracture should undergo surgery immediately, to reset the dislocation and correct ulnar deformity, thereby releasing the compression or traction of the PIN. If PIN injury is complete and irreversible, tendon transfer can be performed to restore the functions of the wrist, finger, and thumb.…”

Section: Discussionmentioning

confidence: 99%

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Type III Monteggia fracture with posterior interosseous nerve injury in a child

Wang

Chen²,

Du³

2017

Medicine

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Rationale:Elbow injury in children by improper treatment or a delay of more than 3 weeks could lead to old unreduced Monteggia fracture, which are difficult to manage. Conservative or normal surgical methods usually fail.Patient concerns:Herein, we present a 6-year-old boy with sustaining injury approximately 1 month to his left elbow. Activity in his elbow was restricted, and his ability to extend his wrist and fingers was impaired.Diagnoses:Type III Monteggia elbow fracture-dislocation consisting of radial head dislocation and malunion of the ulna associated with posterior interosseous nerve palsy were confirmed, which requiring surgical treatment.Interventions:A closed reduction was performed with hyperplastic scar tissues erased and the radial head relocated.Outcomes:Follow-up 4 months later showed satisfactory recovery of function.Lessons:Forearm fractures in children may be misjudged, and that early anatomical reduction rather than conservative treatment may be required.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Type III Monteggia fracture with posterior interosseous nerve injury in a child

Wang

Chen²,

Du³

2017

Medicine

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“…Some authors state that ALR has no effect on radial head stability at all. 2 Others emphasise that ALR may contribute to stability of radial head reduction, but it cannot stabilise the radial head when the forearm is malaligned 13,29 and some even claim that ALR is the primary stabilisator in radial head reduction. 4,31,39 Most authors agree that reconstruction of the annular ligament may contribute to radial head stability.…”

Section: Alrmentioning

confidence: 99%

“…Pain, loss of range of motion (ROM) and neurologic complaints can occur, primarily because of scarring, chronic compressive changes, or due to nerve entrapment in the (sub)luxating joint. 1,2 In the growing child, long-standing radial head dislocation may therefore cause deformity of the radial head, overgrowth of the proximal radius, instability and early osteoarthritic changes of the elbow joint. [3][4][5][6][7] Furthermore, the ulna is relatively shortened, which may lead to complaints at the level of the wrist.…”

Section: Introductionmentioning

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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“…Proper fixation of these fractures is necessary to avoid potential complications, such as forearm deformity (Goh, 2008), elbow stiffness (Ring et al, 2006) and nerve palsy (Ruchelsman et al, 2009). Furthermore, persistent radial head dislocations associated with Monteggia fracturedislocations have been described in the past as being caused by a relative malalignment of the ulna (Cheung and Yao, 2009) which causes entrapment of structures such as the annular ligament, anterior capsule, biceps tendon, and radial and median nerve.…”

Section: Consequences Of the Fracturementioning

confidence: 99%

Type I Monteggia fracture-dislocation in a monk from a 17th-18th century necropolis of Valladolid (Spain)

López

Caro

Pardiñas

2011

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This paper reports the study of the osseous remains of an adult male (30-35 years) from a Spanish urban necropolis dating from the pre-industrial age (17th-18th centuries). We have diagnosed the presence of a severe unreduced forearm fracture, which has been classified as a Type I Monteggia fracture in the left arm. Injury occurred by a complete and poorly resolved ulnar fracture in its upper third. As result of this ulna fracture a radial head dislocation also occurred, creating a new articular surface on the humerus. The ulna also underwent two different types of angulation. The purpose of this study is to evaluate the anatomical changes of the elbow joint bones after a Monteggia fracture, assessing the completeness of functionality on the arm of this man. After the fracture, this individual lived the rest of his life with a permanent dislocation of his radius; therefore, loss of the forearm rotation, cubitus valgus, elbow instability and pain were all present. Movement was limited to an intermediate position or semipronative. A detailed description of the pathology is also accompanied by a discussion of the historical-cultural context in which this man lived and the common diseases of the population to which he belonged.

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Persistent Posterior Interosseous Nerve Palsy Associated with a Chronic Type I Monteggia Fracture-Dislocation in a Child: A Case Report and Review of the Literature

Cited by 17 publications

References 45 publications

Type III Monteggia fracture with posterior interosseous nerve injury in a child

Type III Monteggia fracture with posterior interosseous nerve injury in a child

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

Type I Monteggia fracture-dislocation in a monk from a 17th-18th century necropolis of Valladolid (Spain)

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