Use of Corrective Ulnar Osteotomy and Radial Head Relocation Into Preserved Annular Ligament in the Treatment of Radiocapitellar Instability Secondary to Pediatric Chronic Monteggia Fracture–Dislocation

Baydar, Mehmet; Öztürk, Kahraman; Orman, Osman; Akbulut, Deniz; Keskinbıçkı, Mehmet Vakıf; Şencan, Ayşe

doi:10.1016/j.jhsa.2021.05.025

Cited by 10 publications

(18 citation statements)

References 23 publications

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“…Surgical treatment aims at correcting the angular deformity of the ulnar, stably reducing the radial head and restoring the proper alignment of the radiocapitellar joint (1,2,3,15,19,20,32,40,41,42). Though numerous studies have reported different treatments of NMF, which vary from position to perform osteotomy, options for fixation, and the reconstruction of the annular ligament, there still remains no standard protocol or guidelines (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,…”

Section: Treatment and Complicationsmentioning

confidence: 99%

“…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).…”

Section: Forearm Osteotomymentioning

confidence: 99%

“…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). Bouyala technique, which contains elbow joint clear operation, proximal ulna shaft osteotomy, and correction-over-correction of the angulation deformity of the ulna for radial head reduction through Boyd's posterior approach or Kocher's approach and sometimes combined with Henry's anterior approach, was once universally approved treatment for NMF (2,15,17,23,24,29,39,48). This technique was also successful in treating adult NMF patients and long-term outcomes were satisfactory (43).…”

Section: Forearm Osteotomymentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Neglected Monteggia fracture: a review

Zhang

Wang

et al. 2022

EFORT Open Reviews

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Monteggia fracture is characterized by radial head dislocation combined with proximal ulnar fracture. If not diagnosed at an early stage, these lesions can gradually lead to forearm deformities and dysfunction, finally resulting in neglected Monteggia fracture. When the radial head is not reduced, several deformities develop at the humeroradial joint, including cubitus valgus and osteoarthritis. Adequate radiographs are crucial when the surgeons deal with forearm injuries. At present, proximal ulnar osteotomy and open reduction of chronic radial head dislocation provides satisfactory functional outcomes because of anatomic alignment reconstruction. Supplementary procedures, including transcapitellar pinning and repair or reconstruction of the annular ligament, which are performed in order to enhance stability of the humeroradial joint, should be thoroughly assessed based on joint rotational stability after reduction and on potential complications.

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Section: Treatment and Complicationsmentioning

confidence: 99%

Section: Forearm Osteotomymentioning

confidence: 99%

Section: Forearm Osteotomymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Neglected Monteggia fracture: a review

Zhang

Wang

et al. 2022

EFORT Open Reviews

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“…However, radial head re-dislocation and forearm rotation limitation are still the most common complications in the surgical treatment of neglected Monteggia lesion 2 . Angulation in the opposite direction after ulnar osteotomy is an effective measure to prevent postoperative complications 5 – 9 .…”

Section: Introductionmentioning

confidence: 99%

Influence of ulnar bow sign on surgical treatment of missed Bado type I Monteggia fracture in children

Liao

Wang

Huang

et al. 2022

Sci Rep

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The present study aimed to explore the influence of ulnar bow on the surgical treatment of Bado type I missed Monteggia fracture in children. A retrospective review of 28 patients was conducted between November 2010 and June 2020. All patients were treated with open reduction of the radial head and ulnar opening wedge osteotomy without annular ligament reconstruction. Four months (range 1–12 months) was the mean interval between injury onset and surgery. The average age of patients at the time of surgery was 6.1 years old (range 2–10 years old). The maximum ulnar bow (MUB) and MUB position (P-MUB) via radiography were evaluated. The patients were divided into two groups according to P-MUB, as follows: middle group (A) included 17 cases, and the MUB was located at 40–60% of the distal ulna; and distal group (B) included 11 cases, and the MUB was located at 20–40% from the distal end of the ulna. The mean follow-up period was 33 months (range 6–102 months). At the last follow-up, all the children showed stable reduction of the radial head, and the flexion function of elbow joint improved after the operation (P < 0.05). Group A presented a larger ratio of maximum ulnar bow (R-MUB) and angle of ulnar osteotomy (OA) than group B (P < 0.05). The osteotomy angle was positively correlated with the R-MUB (R2 = 0.394, P = 0.038). The osteotomy angle was positively correlated with the P-MUB (R2 = 0.683, P = 0.000). The R-MUB was proportional to the P-MUB (R2 = 0.459, P < 0.0001). The regression equation of P-MUB and osteotomy angle was as follows: OA = 32.64* P-MUB + 7.206. If the ulnar bow was positioned at the middle ulna, then a stable reduction of radial head needed to be achieved through a large angle in the ulnar osteotomy. If the position of maximum ulnar bow (P-MUB) was closer to the middle of the ulna, or the ratio of maximum ulnar bow (R-MUB) was larger, then the osteotomy angle was larger.

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Ulnar osteotomy and monolateral external fixator for the treatment of chronic Monteggia fractures in children: comparison between gradual and acute radial head reduction

Liu

Shi

et al. 2023

Journal of Pediatric Orthopaedics B

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This study evaluated the outcomes of chronic Monteggia fractures (CMFs) treated by ulnar osteotomy and monolateral external fixator (MEF), and compare the outcome of gradual versus acute radial head reduction. Two groups of patients were identified. Group 1: gradual reduction of the radial head (n = 13); group 2: acute reduction (n = 6). Clinical outcome was evaluated by Kim Elbow Score, whereas radiographic outcome was assessed on plain radiographs. The effect of age, side, time from initial trauma to surgery, rate of unplanned surgery, amount of angulation and lengthening, and final outcome were evaluated. Univariate analysis was performed to identify factors associated with good radiographic outcome. Thirteen patients underwent gradual correction of the ulna. The mean duration of correction was 43.4 days (range, 21–82); the mean angulation and lengthening of the ulna were 22.8° (range, 0°–35°) and 22.2 mm (range, 12.2–40.9), respectively. Six patients underwent acute reduction intraoperatively, the mean angulation and lengthening of the ulna were 17.2° (range, 4°–33.9°) and 5.2 mm (range, 2.5–12.2), respectively. CMF treated by ulnar osteotomy and gradual distraction had better radiological outcome (Group 1; 92.3% 12/13) than those treated by acute reduction of the radial head (Group 2; 3/6, 50%) (P = 0.071). Reoperation rate was found to be significantly correlated with a fair or poor radiographic results (P = 0.016). Good clinical and radiological outcomes should be expected in CMF patients treated by gradual lengthening and angulation of the ulna with a MEF.

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Use of Corrective Ulnar Osteotomy and Radial Head Relocation Into Preserved Annular Ligament in the Treatment of Radiocapitellar Instability Secondary to Pediatric Chronic Monteggia Fracture–Dislocation

Cited by 10 publications

References 23 publications

Neglected Monteggia fracture: a review

Neglected Monteggia fracture: a review

Influence of ulnar bow sign on surgical treatment of missed Bado type I Monteggia fracture in children

Ulnar osteotomy and monolateral external fixator for the treatment of chronic Monteggia fractures in children: comparison between gradual and acute radial head reduction

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