To Angulate or Not to Angulate the Ulna during the Progressive Distraction Period Performed with a Monolateral External Fixator in Paediatric Patients with a Chronic Monteggia Fracture?

Abstract

Background and Objectives: The purpose of this study was to compare the clinical and radiographic evolution of chronic Monteggia fractures (CMFs) treated by ulnar osteotomy and monolateral external fixators (MEFs) with or without angulation of the ulna during the distraction period. Materials and Methods: This retrospective study evaluated 20 children (14 boys and 6 girls) with CMFs. According to the strategy of ulnar lengthening, two groups of patients were identified: patients undergoing gradual lengthening with (Group A, n = 11) or without ulna angulation (Group B, n = 9). The mean age at the time of surgery was 7.7 years old (range, 5.4–12.9). The mean time from initial trauma to surgery was 26.3 months (range, 1–96), and the mean follow-up was 24.6 months (range, 5.5–45.4). Clinical outcomes were evaluated by Kim et al.’s Elbow Performance Score, while radiographic outcomes were assessed on plain radiographs. Results: Age at surgery, sex, laterality, time between trauma and surgery, and time of follow up in the two groups of patients showed no significant differences. The radial head was successfully reduced in 9 of 9 and 10 of 11 patients in Groups B and A, respectively (p = 1.00). The mean time to achieve radial head reduction was shorter in Group B (18.1 ± 5.3 days) than in Group A (39.2 ± 18.7 days; p = 0.004). The mean angulation of the ulna at the end of treatment was significantly lower in Group B (0.6° ± 1.1°) than in Group A (25.9° ± 6.3°; p < 0.0001). The average ulnar lengthening at the end of treatment in Group B (14.1 ± 5.8 mm) was, on average, 7.7 mm less than that in Group A (21.8 ± 9.7 mm; p = 0.05). The Kim et al. Elbow Performance Score at the last follow-up visit was comparable between the two groups of patients (p = 1.00). Conclusions: A shorter time to achieve radial head reduction and less deformity of the ulna can be expected in paediatric patients with CMFs undergoing intraoperative restoration of ulnar alignment and gradual lengthening without angulation postoperatively.

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

“…However, the remnants of ALR are often attenuated and difficult to recognize and repaired. Some reports have advocated that reconstruction of the ALR is not necessary, because of possible problems, including restriction of the rotation of the radial neck and vascular necrosis of the radial head [12,16] . Therefore, we removed the interposed soft tissues and fractured ALR.…”

Diagnosis and treatment of “medial to lateral diagonal injury of the elbow” in children: Concomitant medial epicondylar and radial neck fractures

“…Loss of ROM was defined as a reduction in ROM of more than 20° in each direction. The upper extremity function was evaluated using Elbow Performance Score (EPS) proposed by Kim et al, 14 which is a composite score out of 100 with higher scores reflecting better results 15 (deformity: 25; pain: 25; ROM: 25; function: 25). The functional outcome of the elbow is graded as excellent (score: ≥90), good (score: 75–89), satisfactory (score: 60–74), or poor (score: <60).…”

Missed Monteggia Injuries in Children and Adolescents: A Treatment Algorithm

“…If a length discrepancy is present in addition to the radial head dislocation due to a long-standing Monteggia injury, a complex corrective procedure is required. Multiplanar correction of the deformity can be performed either with a monolateral fixator or in complex deformities with a computerized ring fixator [39][40][41][42]. Gradual distraction should start after a latency of 5-7 days at a rate of 3 × 0.25 mm to a maximum of 4 × 0.25 mm per day, and continued until reduction of the radial head is achieved.…”