The use of external fixation for the management of acute and chronic Monteggia fractures in children

Abstract

PurposeThe main objective of this study was to retrospectively evaluate the clinical and radiological outcomes of acute (AMF) and chronic Monteggia fractures (CMF) in children treated by closed or open reduction and external fixation (EF).MethodsThis is a retrospective review of 26 patients with Monteggia fracture. Patients with AMF (time between trauma and surgery less than two weeks) were treated by closed reduction and EF of the ulna (Group A; 15 patients) while those with CMF (time between trauma and surgery more than three weeks) were managed by closed or open reduction and EF of the ulna (Group B; 11 patients). Clinical outcome was evaluated with radiography and the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). Complications were recorded in both groups.ResultsNo secondary displacement, wire migration, consolidation delays, nonunion, malunion or re-fracture was noted. However, one patient in Group A (6.7%) developed heterotopic ossification of the ulna; the final functional outcome was good (Quick DASH score: 18.2). One case of postoperative redislocation of the radial head was detected in Group B (9.1%). Two patients (7.6%) developed transient pin tract infection. Despite the fact that 16 out of 26 patients (six in Group A and ten in Group B) complained of the clinical appearance and/or had intermittent residual pain on the injured side, the results were essentially the same between the two groups of patients (p > 0.05).ConclusionEF is an alternative for the management of acute and chronic paediatric Monteggia fractures. It provides satisfactory radiological and clinical outcomes with relatively low rates of complications.Level of evidenceIV

Irreducible Traumatic Radial Head Dislocation Due to Annular Ligament Interposition in a Child with Ulnar Plastic Deformation: A Case Report

“…It is pertinent to point out that the term "Monteggia fracture" refers to all fractures of the ulna, irrespective of the location, associated with dislocation of the radial head 28,29 . If the fracture goes undetected and/or is not promptly treated, it may lead to ulnar malunion and persistent radial head dislocation with subsequent loss of function, pain, degenerative arthritis and, in some cases, late neuropathy 30,31 . In our patient, plain radiographs showed an anterior medial dislocation of the radial head and a plastic bowing of the ulna so it could be classified as Bado type I equivalent or Letts type.…”

Successful Treatment of Chronic Monteggia Fracture-dislocations in Children---A New Reference

“…Recently, external xation has been reported to be a safe and effective methods to treat this injury. Bor, Yuan, and Lu [23][24][25] all reported their experience using external xation to capture the ulna osteotomy's optimal position to achieve the best possible reduction of the radial head. However, wearing huge external xation for several months might leave psychological problems.…”

Neglected Monteggia fracture: a review

“…It is undisputed that forearm osteotomy should be performed to correct bony malunion of the ulna, as the angulation deformity is the direct reason for blocking the radial head from reduction (14,15,16,17,19,21,34,38,44,47,48,49,62,75). Ulnar osteotomy and lengthening have been found useful to create intrinsic tension in the interosseous membrane to maintain the reduction of the radial head (1,2,40).…”

“…Plenty of researchers have reported managements of NMF with different outcomes in recent years (9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49). This review aims at summarizing and discussing the current knowledge of NMF, including its definition, its pathophysiological characteristics, the biomechanics of which the radial head slips, and surgical intervention.…”