1
|
Martinelli F, Celli A, Celli L. Belated posterior interosseous nerve palsy with chronic radial head dislocation: a case report. JSES Rev Rep Tech 2024; 4:324-327. [PMID: 38706677 PMCID: PMC11065743 DOI: 10.1016/j.xrrt.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Federico Martinelli
- Upper Limb and Peripheral Nerve Surgery Unit, Hesperia Hospital, Modena, Italy
| | - Andrea Celli
- Upper Limb and Peripheral Nerve Surgery Unit, Hesperia Hospital, Modena, Italy
| | - Luigi Celli
- Upper Limb and Peripheral Nerve Surgery Unit, Hesperia Hospital, Modena, Italy
| |
Collapse
|
2
|
Le Mapihan M, Amsallem L, Ing D, Masméjean EH. Midterm outcomes of a short-cemented bipolar radial head arthroplasty, in a cohort of 56 cases with minimum 2-years follow-up. Orthop Traumatol Surg Res 2024; 110:103716. [PMID: 37865236 DOI: 10.1016/j.otsr.2023.103716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 10/23/2023]
Abstract
BACKGROUND Radial head prostheses are used in comminuted radial head fractures for elbow stabilisation when reduction and internal fixation is not possible. Several implant designs exist, but no large series exist about a short-cemented and bipolar implant. HYPOTHESIS The hypothesis was that this prosthesis design shows good clinical, functional, and radiological results, with acceptable rate of complications. STUDY DESIGN This retrospective study included the prostheses with bipolar design and short-cemented stem (Evolutive™), with a minimum 2-years follow-up. MATERIALS AND METHODS All prosthesis implanted in our Traumatology Center were included, with minimum 2-years follow-up. The evaluation consisted of a clinical and functional evaluation, associated with an independent radiographic assessment. All complications were listed, as long as rate and reasons for implant removal. RESULTS Fifty-six implants were studied with a mean follow-up of 64.9months (24 to 119). Fifty-three cases were acute injuries with 16% isolated radial head fractures and 76% complex elbow injury such as ulno-humeral, radio-ulnar or longitudinal forearm instability. Fifty (89%) implants were still in place at last follow-up. The main reason for implant removal was during arthrolysis procedure. Ranges of motion were: 126° in flexion, 9° of extension loss, 76° of pronation and 79° of supination. Mean Mayo Elbow Performance Index was 84.1 with 72% of excellent or good results, and the median quick-DASH was rated 18.2. Radiographic evaluation found 12% significant ulno-humeral arthtitis, 64% capitellar osteopenia and 12% loosening. We recorded 5% of implant-related complications. DISCUSSION The short-cemented stem bipolar radial head prosthesis presents clinical and functional results similar to other radial head prosthesis with low incidence of elbow arthritis, when treating both isolated radial head fracture or complexes elbow injury. This implant should therefore be valid for treating comminuted radial head fractures in all types of traumatological injuries. LEVEL OF EVIDENCE IV; Retrospective cohort study.
Collapse
Affiliation(s)
- Marie Le Mapihan
- Hand, upper limb and peripheral nerve surgery service, Georges-Pompidou European Hospital (HEGP), Paris, France; Université de Paris Cité, Paris, France.
| | - Lior Amsallem
- Hand, upper limb and peripheral nerve surgery service, Georges-Pompidou European Hospital (HEGP), Paris, France; IECEM - Polyclinique Saint-Côme, Compiègne, France
| | - David Ing
- General radiology service, Georges-Pompidou European Hospital (HEGP), Paris, France
| | - Emmanuel H Masméjean
- Université de Paris Cité, Paris, France; Clinique Sainte Genevieve Groupe Pauchet, 75014 Paris, France.
| |
Collapse
|
3
|
Barlow JD, Nieboer MJ, Cancio-Bello AM, Morrey ME, Hidden KA, Yuan BJ, Sanchez-Sotelo J, O'Driscoll SW. A coronoid-centric classification system of proximal trans-ulnar fracture-dislocations has almost perfect intraobserver and interobserver agreement. J Shoulder Elbow Surg 2023; 32:2561-2566. [PMID: 37479178 DOI: 10.1016/j.jse.2023.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Fracture-dislocations of the elbow, particularly those that involve a fracture through the proximal ulna, are complex and can be difficult to manage. Moreover, current classification systems often cannot discriminate between Monteggia-variant injury patterns and trans-olecranon fracture-dislocations, particularly when the fracture involves the coronoid. The Mayo classification of proximal trans-ulnar fracture-dislocations categorizes these fractures into 3 types according to what the coronoid is still attached to: trans-olecranon fracture-dislocations (the coronoid is still attached to the ulnar metaphysis); Monteggia-variant fracture-dislocations (the coronoid is still attached to the olecranon); and ulnar basal coronoid fracture-dislocations (the coronoid is not attached to either the olecranon or the ulnar metaphysis). The purpose of this study was to evaluate the intraobserver and interobserver agreement of the Mayo classification system when assessing elbow fracture-dislocations involving the proximal ulna based on radiographs and computed tomography scans. METHODS Three fellowship-trained shoulder and elbow surgeons and 2 fellowship-trained orthopedic trauma surgeons blindly and independently evaluated the radiographs and computed tomography scans of 90 consecutive proximal trans-ulnar fracture-dislocations treated at a level I trauma center. The inclusion criteria included subluxation or dislocation of the elbow and/or radioulnar joint with a complete fracture through the proximal ulna. Each surgeon classified all fractures according to the Mayo classification, which is based on what the coronoid remains attached to (ulnar metaphysis, olecranon, or neither). Intraobserver reliability was determined by scrambling the order of the fractures and having each observer classify all the fractures again after a washout period ≥ 6 weeks. Interobserver reliability was obtained to assess the overall agreement between observers. κ Values were calculated for both intraobserver reliability and interobserver reliability. RESULTS The average intraobserver agreement was 0.87 (almost perfect agreement; range, 0.76-0.91). Interobserver agreement was 0.80 (substantial agreement; range, 0.70-0.90) for the first reading session and 0.89 (almost perfect agreement; range, 0.85-0.93) for the second reading session. The overall average interobserver agreement was 0.85 (almost perfect agreement; range, 0.79-0.91). CONCLUSION Classifying proximal trans-ulnar fracture-dislocations based on what the coronoid remains attached to (olecranon, ulnar metaphysis, or neither) was associated with almost perfect intraobserver and interobserver agreement, regardless of trauma vs. shoulder and elbow fellowship training. Further research is needed to determine whether the use of this classification system leads to the application of principles specific to the management of these injuries and translates into better outcomes.
Collapse
Affiliation(s)
| | - Micah J Nieboer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Krystin A Hidden
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brandon J Yuan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | |
Collapse
|
4
|
Khadka M, Pant S, KC M, Koirala A, Bhandari R, Poudel A. Proximal radioulnar synostosis following Monteggia fracture-dislocation: a case report. Ann Med Surg (Lond) 2023; 85:6218-6221. [PMID: 38098539 PMCID: PMC10718384 DOI: 10.1097/ms9.0000000000001420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/09/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction and importance Radioulnar synostosis is a rare complication of a forearm fracture that restricts pronation-supination. This study presents a case of proximal radioulnar synostosis in an adult male after Monteggia fracture-dislocation who had a loss of pronation and supination movements. Case presentation Herein, we report a case of proximal radioulnar synostosis in a 43-year-old man who presented with loss of pronation and supination of the right forearm that restricted his daily activities. He had a history of Monteggia fracture-dislocation 9 months back, which was managed with open reduction and internal fixation with a dynamic compression plate. Plain radiography and computed tomography of the right forearm after 9 months of operation showed an implant in situ with proximal radioulnar synostosis. Implant removal was performed and the excess fibro-osseous connection in the proximal radius and ulna was removed. Clinical discussion Forearm injuries that affect the interosseous membrane may result in radioulnar synostosis. Trauma and treatment-related factors increase the risk of radioulnar synostosis. The fibro-osseous fusion between the forearm bones restricts the pronation and supination movements. Conclusion Loss of pronation-supination following forearm fracture should raise suspicion of radioulnar synostosis.
Collapse
Affiliation(s)
| | - Sakar Pant
- Nepalese Army Institute of Health Sciences
| | - Manoj KC
- Nepalese Army Institute of Health Sciences
| | | | - Ravi Bhandari
- Department of Orthopaedics, Shree Birendra Hospital, Kathmandu, Nepal
| | - Arjun Poudel
- Department of Orthopaedics, Shree Birendra Hospital, Kathmandu, Nepal
| |
Collapse
|
5
|
Uzun A, Rdan JA, Balcı EB, Deniz E, Mahoutforoush M, Kara A. Atypical Monteggia Fracture Dislocation Type 3 Equivalent Lesion in a 4- Year- Old Boy. J Orthop Case Rep 2023; 13:24-27. [PMID: 38025349 PMCID: PMC10664215 DOI: 10.13107/jocr.2023.v13.i11.3992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/05/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Monteggia fracture dislocations are relatively common and debilitating traumas in <10 years of age. This is the second case reporting Monteggia type 3 equivalent injury treated by the same way while the first being reported also by our team in 2016. Case Report A 4-year-old Caucasian male patient was admitted to our clinic by his parents at the day after his fall. A long arm splint was applied with the diagnosis of Monteggia fracture dislocation in another hospital. Conclusion Bado introduced his classification system for Monteggia fracture dislocations in 1967. This classification system is mainly based on the direction of dislocation of the radial head. If radial head dislocated laterally with an accompanying ulnar fracture it is classified as Bado type 3 while type 4 is the anterior dislocation of the radial head accompanied with both bone forearm fracture. The unusual fracture dislocation pattern in our case is that lateral dislocation of the radial head is accompanied with both bone forearm fracture, which is an example to be named as Monteggia type 3 equivalent lesion. Closed reduction was not successful to reduce radial head. To reduce the radial head, we used an intramedullary Kirschner and a long arm splint was applied to ensure the safety of the reduction. There was no restriction in elbow movements and the result of the operation was successful.
Collapse
Affiliation(s)
- Alparslan Uzun
- Department of Orthopaedics and Traumatology, Istanbul Medipol University, School of Medicine, TEM Avrupa Otoyolu, Göztepe Çıkışı No: 1, 34214, Bağcılar, Istanbul, Turkey
| | - Joud Abou Rdan
- Medical Faculty, Istanbul Medipol University, School of Medicine, Göztepe Mahallesi, Atatürk Caddesi, No:40, 34810, Kavacık, Istanbul, Turkey
| | - Elif Betül Balcı
- Medical Faculty, Istanbul Medipol University, School of Medicine, Göztepe Mahallesi, Atatürk Caddesi, No:40, 34810, Kavacık, Istanbul, Turkey
| | - Eyüp Deniz
- Medical Faculty, Istanbul Medipol University, School of Medicine, Göztepe Mahallesi, Atatürk Caddesi, No:40, 34810, Kavacık, Istanbul, Turkey
| | - Maral Mahoutforoush
- Department of Orthopaedics and Traumatology, Istanbul Medipol University, School of Medicine, TEM Avrupa Otoyolu, Göztepe Çıkışı No: 1, 34214, Bağcılar, Istanbul, Turkey
| | - Adnan Kara
- Department of Orthopaedics and Traumatology, Istanbul Medipol University, School of Medicine, TEM Avrupa Otoyolu, Göztepe Çıkışı No: 1, 34214, Bağcılar, Istanbul, Turkey
| |
Collapse
|
6
|
Fan Y, Liu Q, Yu X, Zhang J, Wang W, Liu C. Ultrasound, a new adjuvant method for treating acute Monteggia fracture in children. J Orthop Surg Res 2023; 18:595. [PMID: 37568239 PMCID: PMC10422793 DOI: 10.1186/s13018-023-04075-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE This study aims to evaluate the feasibility of using ultrasound-guided Kirschner wire or elastic intramedullary nail for fixation in the treatment of acute Monteggia fracture in children. METHODS A retrospective analysis was conducted on 31 cases of acute Monteggia fracture in children treated with ultrasound-guided Kirschner wire or elastic intramedullary nail fixation between April 2020 and December 2022, including 14 cases of Kirschner wire fixation and 17 cases of elastic intramedullary nail fixation. During the operation, soft tissue compression and nerve and vascular injuries were explored, fracture reduction was performed under ultrasound guidance, and operation time was recorded. After the operation, X-ray examination was conducted to assess the quality of fracture reduction. At the last follow-up, the flexion, extension, pronation, and supination angles of both affected and unaffected elbow joints were measured, and the Mayo score was used to evaluate elbow joint function. RESULTS The average duration of surgery was 50.16 ± 19.21 min (ranging from 20 to 100 min). Based on the evaluation criteria for assessing reduction quality, 28 cases were deemed excellent, while 3 cases were considered good. After immobilization with long-arm cast for 4-6 weeks postoperatively, elbow and forearm rotation exercises were performed. Kirschner wires were removed after an average of 6.64 ± 0.93 weeks (ranging from 6 to 9 weeks) postoperatively, and elastic intramedullary nails were removed after an average of 5.12 ± 1.54 months (ranging from 4 to 10 months) postoperatively. The average follow-up time was 19.13 ± 11.22 months (ranging from 4 to 36 months). During the final follow-up, the affected limb's range of motion in flexion, extension, pronation, and supination was (141.16 ± 4.24)°, (4.61 ± 2.81)°, (84.52 ± 3.74)°, and (84.23 ± 3.69)°, respectively. There was no notable variance when compared to the healthy limb, which had a range of motion of (141.81 ± 2.99)°, (4.81 ± 2.50)°, (85.61 ± 3.12)°, and (85.03 ± 2.73)° (P > 0.05). The Mayo Elbow Performance index classified 29 cases as excellent and 2 cases as good. CONCLUSION Ultrasound-guided Kirschner wire or elastic intramedullary nail fixation can be used for the treatment of acute Monteggia fracture in children, which can explore the surrounding nerves, blood vessels, and soft tissue compression, reduce the difficulty of reduction, and cause minimal trauma. It can greatly reduce the risk of radiation exposure and complications such as vascular and nerve injury during the operation.
Collapse
Affiliation(s)
- YongFei Fan
- Department of Orthopaedic Surgery, Fuyang People’s Hospital Affiliated to Anhui Medical University, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang People’s Hospital, Fuyang, 236000 Anhui People’s Republic of China
| | - QiXin Liu
- Department of Orthopaedic Surgery, Fuyang People’s Hospital Affiliated to Anhui Medical University, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang People’s Hospital, Fuyang, 236000 Anhui People’s Republic of China
| | - XueDi Yu
- Department of Ultrasound, Fuyang People’s Hospital Affiliated to Anhui Medical University, Fuyang People’s Hospital, Fuyang, 236000 Anhui People’s Republic of China
| | - JianQiang Zhang
- Department of Orthopaedic Surgery, Fuyang People’s Hospital Affiliated to Anhui Medical University, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang People’s Hospital, Fuyang, 236000 Anhui People’s Republic of China
| | - Wei Wang
- Department of Orthopaedic Surgery, Fuyang People’s Hospital Affiliated to Anhui Medical University, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang People’s Hospital, Fuyang, 236000 Anhui People’s Republic of China
| | - ChaoYu Liu
- Department of Orthopaedic Surgery, Fuyang People’s Hospital Affiliated to Anhui Medical University, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang People’s Hospital, Fuyang, 236000 Anhui People’s Republic of China
| |
Collapse
|
7
|
Deemer AR, Perskin CR, Littlefield CP, Drake J, Ganta A, Konda S, Egol KA. Fractures of the Proximal Ulna: A Spectrum of Injuries and Outcomes. Indian J Orthop 2023; 57:262-268. [PMID: 36777131 PMCID: PMC9880104 DOI: 10.1007/s43465-022-00793-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Introduction The purpose of this study is to assess the effect of radial head/ neck injury in association with proximal ulna fractures. Methods Between 2006 and 2020, 107 patients presented to our academic medical center for treatment of a proximal ulna fracture and were enrolled into an IRB-approved database. Radiographs, injury details, and surgical interventions were retrospectively reviewed. Patients were classified as having an isolated proximal ulna fracture (PU), a PU fracture with an associated radial head dislocation (M-D), or a Monteggia fracture with an associated radial head fracture (M-V). Clinical and functional outcomes were assessed at follow-up to determine what differences exist between fracture patterns. Statistics were generated using Chi-squared tests for categorical variables and one-way ANOVA tests for numerical variables. Results While all patients ultimately healed, time to radiographic healing in the PU cohort was shorter at 3.57 ± 1.7 months when compared to the M-V cohort (5.67 ± 3.8 months) (p < 0.05). At follow-up, patients in the M-V cohort had poorer elbow pronation and supination when compared to the PU and M-D cohorts (p < 0.05). Patients within the PU cohort had fewer complications than those in the M-D and M-V cohorts (p < 0.05). No differences were found between the three cohorts in regard to rates of reoperation, non-union, wound infection, and nerve compression (p > 0.05). Conclusion The Monteggia fracture with a concomitant radial head/neck fracture is a more disabling injury pattern when compared to an isolated proximal ulna fracture and Monteggia fracture without an associated radial head/neck fracture.
Collapse
Affiliation(s)
- Alexa R. Deemer
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
| | - Cody R. Perskin
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
| | - Connor P. Littlefield
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
| | - Jack Drake
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
| | - Abhishek Ganta
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY USA
| | - Sanjit Konda
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY USA
| | - Kenneth A. Egol
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY USA
| |
Collapse
|
8
|
Tille E, Seidel L, Schlüßler A, Beyer F, Kasten P, Bota O, Biewener A, Nowotny J. Monteggia fractures: analysis of patient-reported outcome measurements in correlation with ulnar fracture localization. J Orthop Surg Res 2022; 17:303. [PMID: 35672754 PMCID: PMC9172148 DOI: 10.1186/s13018-022-03195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Monteggia fractures and Monteggia-like lesions result after severe trauma and have high complication rates. Preliminary biomechanical studies suggested a correlation between ulnar fracture localization and clinical result. OBJECTIVES Key objective was to evaluate whether the site of the ulnar fracture can be correlated to clinical outcome after open reduction and internal stabilization. METHODS In a retrospective, monocentric study 35 patients who underwent surgical treatment after suffering a Monteggia injury or Monteggia-like lesion were included. Fractures were classified according to Bado and Jupiter, the site of the fracture location at the proximal ulna and regarding the potential accompanying ligamentary injury. In a follow-up examination validated patient-reported outcome measures and functional parameters were evaluated. Furthermore, treatment strategy and complications were analysed. RESULTS Mean patient age was 51.9 years (± 18.0). 69% were females (n = 24). Follow-up took place after 50.5 months (± 22.1). Fractures were classified according to Bado (I:2, II:27, III:4, IV:2). Bado II-fractures were further classified according to Jupiter (A:7, B:16, C:3, D:1). Cases were divided into subgroups depending upon the distance of the ulnar fracture site in respect to its distal endpoint (A: < 7 cm and B: > 7 cm). Average overall MEPS was 84.1 (± 19.0). Oxford elbow score and DASH were 37.2 (± 10.5) and 20.4 (± 20.5). Average extension capability reached - 7° (± 7.5). Mean flexion was 134.8° (± 19.7). Average pain according to visual analogue scale was 1.6 (± 1.9). We found no differences between the subgroups regarding the PROMs. Subgroup A displayed a worse extension capability (p = 0.027) and patients were significantly older (p < 0.01). Comparing patients with and without fracture of the radial head, we observed no differences. Patients with an accompanying injury of the coronoid process displayed higher pain levels (p = 0.011), a worse functionality (p = 0.027) and overall lower scoring in PROM. CONCLUSION The presented results suggest that in Monteggia fractures and Monteggia-like lesions, the localization of the ulna fracture can give a hint for its postoperative outcome. However, we could not confirm the hypothesis of an increasing instability in ulnar fractures located further distally (high severity of the potential ligamentous injury). Intraarticular fractures or injuries with a close relation to the joint have a worse prognosis, especially if the coronoid process is injured. Trial registration Registration was done with ClinicalTrials.gov under NCT05325268.
Collapse
Affiliation(s)
- Eric Tille
- University Centre for Orthopaedic, Trauma- and Plastic Surgery (OUPC), University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - L Seidel
- University Centre for Orthopaedic, Trauma- and Plastic Surgery (OUPC), University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - A Schlüßler
- University Centre for Orthopaedic, Trauma- and Plastic Surgery (OUPC), University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Franziska Beyer
- University Centre for Orthopaedic, Trauma- and Plastic Surgery (OUPC), University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - P Kasten
- Orthopaedic Surgery Centre (OCC), Tübingen, Germany
| | - O Bota
- University Centre for Orthopaedic, Trauma- and Plastic Surgery (OUPC), University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - A Biewener
- University Centre for Orthopaedic, Trauma- and Plastic Surgery (OUPC), University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - J Nowotny
- University Centre for Orthopaedic, Trauma- and Plastic Surgery (OUPC), University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Centre for Translational Bone, Joint and Soft Tissue Research, Technical University Dresden, Dresden, Germany
| |
Collapse
|
9
|
Zhang R, Wang X, Xu J, Kang Q, Hamdy RC. Neglected Monteggia fracture: a review. EFORT Open Rev 2022; 7:287-294. [PMID: 35446261 PMCID: PMC9069855 DOI: 10.1530/eor-21-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Rui Zhang
- Department of Orthopedics, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaoyu Wang
- Department of Orthopedics, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai, China
| | - Jia Xu
- Department of Orthopedics, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai, China
| | - Qinglin Kang
- Department of Orthopedics, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai, China
| | - Reggie C Hamdy
- Department of Pediatric Surgery, Montreal General Hospital, Montreal, Quebec, Canada
| |
Collapse
|
10
|
Begkas DG, Michelarakis IN, Papamerkouriou YML. Missed Monteggia Fracture Dislocation in a 10-year-old Child - A Step-by-Step Approach to Properly Solving a Complex Problem: A Case Report. J Orthop Case Rep 2022; 12:41-44. [PMID: 35611299 PMCID: PMC9091389 DOI: 10.13107/jocr.2022.v12.i01.2610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/20/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Monteggia injuries are relatively rare in the pediatric population. They can be missed leading to complications arising from a chronic radial head dislocation. There is limited information about their proper management in the literature. Thus, their treatment remains controversial. Case Report We present a case of a 10-year-old boy who was examined in the orthopedic outpatient clinic of our hospital, due to limited range of motion of his left elbow and difficulty in extending his left thumb, after a forearm injury which occurred 9 months before and was initially treated conservatively. After appropriate imaging was obtained, a Bado type I Monteggia lesion was diagnosed. This was treated by open reduction of the head of radius, osteotomy of the ulna and lengthening using an external fixator, as well as annular ligament reconstruction by the use of synthetic tendon graft. The patient was followed up for 18 months after surgery and during his last examination showed very good clinical and functional results. Conclusion Missed Monteggia injuries in children are complex problems warranting a step-by-step approach. Their management with ulnar osteotomy, bone lengthening, and reconstruction of the annular ligament presents a viable option with excellent clinical, functional, and radiological outcomes.
Collapse
Affiliation(s)
- Dimitrios G Begkas
- Department of Orthopaedics, Asclepieion Voulas General Hospital, Voula, Greece,Address of Correspondence: Dr. Dimitrios G Begkas, Department of Orthopaedics, Asclepieion Voulas General Hospital, 1 Vasileos Pavlou Street, Voula - 16673, Athens, Greece. E-mail:
| | - Ioannis N Michelarakis
- Department of Orthopaedics, “Panagiotis and Aglaia Kyriakou” Athens General Children’s Hospital, Athens, Greece
| | | |
Collapse
|
11
|
Xie KB, Hao BC. [Closed manipulative reduction and external fixation with cardboard splint for the treatment of Monteggia fracture]. Zhongguo Gu Shang 2021; 34:870-5. [PMID: 34569215 DOI: 10.12200/j.issn.1003-0034.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore clinical efficicacy of closed manipulative reduction and external fixation with cardboard splint in treating Monteggia fracture. METHODS Fifty-eight children with Monteggia fracture were underwent closed manipulative reduction and external fixation with cardboard splint from January 2010 to Junuary 2018. Among them, including 37 males and 21 females, aged from 3.5 to 12 years old with an average of (8.48±2.29) years old;the courses of disease ranged from 0.5 hours to 9 days with an average of (4.21±1.46) days. Broberg and Morrey scores before treatment, 1, 3 and 6 months after treatment were used to evaluate clinical effects. RESULTS All children were followed up from 1 to 6 months with an average of (3.35±2.12) months. Broberg and Morrey score (7.24±2.81) before treatment, (32.06 ±8.33) at 1 month after treatment, (73.18±5.56) at 3 months after treatment and (95.87±6.75) at 6 months after treatment; there were statistical differences at each time points after treatment with before treatment (P<0.05);37 children got excellent results, 19 good and 1 moderate. CONCLUSION Treatment of Monteggia fractures with closed manipulative reduction and external fixation with cardboard splint could reach integration of motion and quietness, also could remove external fixation at early stage, and get obvious short-term and medium-term therapeutic results.
Collapse
Affiliation(s)
- Ke-Bo Xie
- Department of Orthopaedics, Beijing Fengsheng Special Hospital of Traditional Medical Traumatology and Orthopedics, Beijing 100034, China
| | - Bo-Chuan Hao
- Department of Orthopaedics, Beijing Fengsheng Special Hospital of Traditional Medical Traumatology and Orthopedics, Beijing 100034, China
| |
Collapse
|
12
|
Yue J, Mu M, Sun H, Jiang X, Chen X. [Application of annular ligament reposition and repair via Henry's approach for Monteggia fracture in children]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021; 35:562-566. [PMID: 33998208 DOI: 10.7507/1002-1892.202012106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of annular ligament reposition and repair via Henry's approach for Monteggia fracture in children. Methods A clinical data of 21 children with Monteggia fractures was retrospectively analysed, who underwent open reduction of the radial head and annular ligament reposition and repair via Henry's approach between May 2015 and July 2019. There were 11 boys and 10 girls with an average age of 8 years and 1 month (range, 4 years and 5 months to 14 years and 4 months). The fracture was caused by falling in 17 cases and by falling from height in 4 cases. There were 16 fresh fractures and 5 old fractures. The Monteggia fractures were rated as Bado typeⅠin 14 cases and Bado type Ⅲ in 7 cases. Preoperative MRI examination and intraoperative observation confirmed that the annular ligament was intact. After operation, the fracture healing, elbow range of motion (ROM), and complications were recorded, and the effectiveness was evaluated according to the Mackay's function scoring system. Results The incisions healed by first intention after operation, and there was no complication such as radial nerve injury. All children were followed up 12-25 months, with an average of 15 months. No dislocation or subluxation of the radial head occurred after operation. At last follow-up, the ROM of elbow flexion and extension of the children with old fractures increased from (92.6±11.2)° before operation to (123.6±11.6)°, and the ROM of forearm rotation from (96.8±11.8)° to (129.8±5.9)°; the differences between pre- and post-operation were significant ( t=7.672, P=0.002; t=9.487, P=0.001); the ROM of elbow flexion and extension of the children with fresh fractures was 139°-156° (mean, 145°); the ROM of forearm rotation was 158°-168° (mean, 162°). According to Mackay's criteria, 17 cases were excellent and 4 cases were good, with an excellent and good rate of 100%. X-ray film examination showed no nonunion, heterotopic ossification, or loosening of internal fixation after operation. The ulnar fracture and the ulnar osteotomy healed in all cases. Conclusion The annular ligament in Monteggia fractures in children is intact. Compared with the reconstruction of the annular ligament, the reposition and repair of the annular ligament via Henry's approach is closer to the original anatomical state of the annular ligament and has the advantages of less trauma and fewer complications.
Collapse
Affiliation(s)
- Junyi Yue
- Department of Orthopedics, Yantaishan Hospital, Yantai Shandong, 264000, P.R.China
| | - Mingzhang Mu
- Department of Orthopedics, Yantaishan Hospital, Yantai Shandong, 264000, P.R.China
| | - Hongmei Sun
- Department of Orthopedics, Yantaishan Hospital, Yantai Shandong, 264000, P.R.China
| | - Xiaoyan Jiang
- Department of Orthopedics, Yantaishan Hospital, Yantai Shandong, 264000, P.R.China
| | - Xu Chen
- Department of Orthopedics, Yantaishan Hospital, Yantai Shandong, 264000, P.R.China
| |
Collapse
|
13
|
Gradek J, Rawo T, Psuja A, Gawelowicz K, Kąpiński J, Waśko MK. Outcomes of Treatment of Monteggia Fractures with Reduction and Internal Titanium Elastic Nail Fixation of the Ulna. Ortop Traumatol Rehabil 2021; 23:79-91. [PMID: 33958497 DOI: 10.5604/01.3001.0014.8137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this paper is to evaluate the usefulness of radiographic indices of humero-radial joint instability in order to predict treatment outcomes in Monteggia fractures. MATERIAL AND METHODS A retrospective analysis was conducted in a group of patients who underwent closed reduction and internal titanium elastic nail (TEN) fixation of the ulna and closed reduction of a dislocation of the radial head between 2016 and 2018. The indications for intrame-dullary fixation comprised transverse or short oblique fractures. The direction of the dislocation was classified according to Bado. The following radiographic indies were assessed: Radiocapitellar Line, Lateral Humeral Line, Proximity Index, and Radial Head Displacement Index. RESULTS Treatment outcomes were assessed with the Oxford Elbow Score and Mayo Elbow Performance Score, and com-plications were assessed with a modified Clavien-Dindo-Sink scale. No coincidence between poor functional and radio-graphic outcomes was demonstrated. CONCLUSIONS 1. Regardless of the severity of the injury, eligibility for surgery and correctly performed surgical treatment guarantee a good final outcome. 2. Patients treated with TEN regain their preoperative mobility. 3. There was no coincidence between poor functional and radiographic outcomes, except for one patient in whom subluxation of the radial head persisted despite surgery and was confirmed radiographically and functionally. 4. It would be beneficial for clinical practice to introduce simple, reproducible radiographic parameters for unambiguous assessment of the effectiveness of treatment and predicting treatment outcomes; unfortunately none of the parameters we investigated were sufficiently reliable. 5. The radiographic parameters analysed in this paper are dependent on the quality of the radiological examinations performed.
Collapse
Affiliation(s)
- Joanna Gradek
- Oddział Chirurgii Urazowo-Ortopedycznej, Szpital Dziecięcy im. prof. dr. med. Jana Bogdanowicza, Warszawa, Polska / Department of Trauma and Orthopaedic Surgery, Prof. Jan Bogdanowicz Children's Hospital, Warsaw, Poland
| | - Tomasz Rawo
- Oddział Chirurgii Urazowo-Ortopedycznej, Szpital Dziecięcy im. prof. dr. med. Jana Bogdanowicza, Warszawa, Polska / Department of Trauma and Orthopaedic Surgery, Prof. Jan Bogdanowicz Children's Hospital, Warsaw, Poland
| | - Aleksander Psuja
- Oddział Chirurgii Urazowo-Ortopedycznej, Szpital Dziecięcy im. prof. dr. med. Jana Bogdanowicza, Warszawa, Polska / Department of Trauma and Orthopaedic Surgery, Prof. Jan Bogdanowicz Children's Hospital, Warsaw, Poland
| | - Karol Gawelowicz
- Oddział Chirurgii Urazowo-Ortopedycznej, Szpital Dziecięcy im. prof. dr. med. Jana Bogdanowicza, Warszawa, Polska / Department of Trauma and Orthopaedic Surgery, Prof. Jan Bogdanowicz Children's Hospital, Warsaw, Poland
| | - Jacek Kąpiński
- Oddział Chirurgii Urazowo-Ortopedycznej, Szpital Dziecięcy im. prof. dr. med. Jana Bogdanowicza, Warszawa, Polska / Department of Trauma and Orthopaedic Surgery, Prof. Jan Bogdanowicz Children's Hospital, Warsaw, Poland
| | - Marcin K Waśko
- Oddział Chirurgii Urazowo-Ortopedycznej, Szpital Dziecięcy im. prof. dr. med. Jana Bogdanowicza, Warszawa, Polska / Department of Trauma and Orthopaedic Surgery, Prof. Jan Bogdanowicz Children's Hospital, Warsaw, Poland
| |
Collapse
|
14
|
Abstract
Background Monteggia fracture-dislocation is a rare and often missed injury in the paediatric population. The neglected radial head dislocation might go unnoticed for several months, but usually becomes symptomatic at a certain point in time, posing a complex clinical problem. Management strategies for chronic Monteggia lesions have been proposed by many authors. A consensus therapy is nonetheless lacking. In recent years an increasing number of case series reporting the outcomes of various treatment options have been published to gain insight into this challenging pathology. The purpose of this review is to provide a general background on chronic, paediatric Monteggia fracture-dislocation, followed by a systematic analysis and discussion of various management strategies and their outcomes, described in recent outcome studies. Methods A literature search was conducted within the online databases PubMed, Cochrane Central, EMBASE and Google Scholar, to identify outcome studies on the management of chronic Monteggia lesions published between January 2015 and April 2020. A total of 23 outcome studies were identified and included in this study. Results Obtaining stable radial head reduction can be regarded as the main objective of any management strategy for chronic, paediatric Monteggia fracture-dislocation. In recent literature, many surgical techniques have been put forward to obtain this goal, with the mainstay of most treatment strategies being ulnar osteotomy and open reduction with or without reconstruction of the annular ligament. Watchful neglect is a strategy that got more or less abandoned and is challenged in recent literature. Conclusions Due to the complexity of long-standing radial head dislocation and the unpredictability of outcomes in the treatment of chronic Monteggia lesions, early diagnosis and achieving a stable reduction, preferably in the acute setting, are paramount. Because of the tendency to obtain more satisfactory radiological and clinical results in younger patients, with a short injury-to-surgery interval, it is advisable to promptly proceed to surgical treatment when chronic Monteggia fracture-dislocation is diagnosed.
Collapse
Affiliation(s)
- Tom Gryson
- Department of Traumatology, Centre Hospitalier de Luxembourg, 4 Rue Nicolas Ernest Barblé, 1210, Luxembourg, Luxembourg
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - Frank Plasschaert
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| |
Collapse
|
15
|
Alrashidi Y. A Monteggia variant associated with unusual fracture of radial head in a young child: A case report. Int J Surg Case Rep 2020; 78:42-47. [PMID: 33310469 PMCID: PMC7736760 DOI: 10.1016/j.ijscr.2020.11.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 01/09/2023] Open
Abstract
Monteggia fracture is rare among children and its treatment may be challenging. Early recognition of unusual Monteggia variant patterns is crucial to avoid delay in treatment. Adherence to the principles of surgical management in unstable variants is encouraged.
Introduction Monteggia fracture and its variants are not common among children but may be challenging and lead to serious complications if not treated in acute stage. The different types of associated growth plate fractures of proximal radius are not yet clearly defined in any variant classifications. Presentation of case A 6-year-old girl was brought to the emergency room after a fall on the left elbow. The plain radiographs showed unstable fracture of proximal ulna with a laterally displaced and comminuted radial head fracture. The patient was treated surgically as a case of a Monteggia variant. The case has been re-evaluated twenty months following the surgery and did not show any radiological signs of growth disturbance nor residual deformity. Discussion The presented Monteggia variant is rare in terms of associated unique intra-articular fracture of proximal radius. The successful management of the case is based on adhering to the principles of treatment of Monteggia fractures. Conclusion Early recognition of unusual Monteggia variant patterns is crucial to avoid delay in treatment. Adherence to the principles of surgical management in unstable variants is encouraged.
Collapse
Affiliation(s)
- Yousef Alrashidi
- College of Medicine, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia; Department of Orthopedics, King Fahad Hospital, Al-Madinah, Saudi Arabia.
| |
Collapse
|
16
|
Patel M, Dehghan N. Management of Monteggia Injuries in the Adult. Hand Clin 2020; 36:479-484. [PMID: 33040960 DOI: 10.1016/j.hcl.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Monteggia fracture-dislocation of the elbow is a fracture of the proximal ulna with associated dislocation of the radial head or radial neck fracture. In adults, this injury is managed with open reduction and internal fixation of the ulna fracture. Care should be taken to ensure anatomic reduction of the proximal ulna. If radial head dislocation or subluxation persists, reduction of the ulna should be reassessed. Rarely, interposed soft tissue may block radial head reduction, and requires removal. Complications include hardware prominence, stiffness, infection, heterotopic ossification, nerve injury, malunion or nonunion of the ulna, radioulnar synostosis, and persistent radial head instability.
Collapse
Affiliation(s)
- Midhat Patel
- Department of Orthopedic Surgery, University of Arizona College of Medicine - Phoenix, 1320 North 10th Street Suite A, Phoenix, AZ 85006, USA.
| | - Niloofar Dehghan
- The CORE Institute, 18444 North 25th Avenue #210, Phoenix, AZ 85023, USA
| |
Collapse
|
17
|
Khatri K, Rajpal K, Singh J. Bilateral Monteggia Fracture: A Rare Case Presentation. J Orthop Case Rep 2020; 10:76-79. [PMID: 33489975 PMCID: PMC7815674 DOI: 10.13107/jocr.2020.v10.i06.1884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Giovanni Monteggia was the first to describe two cases of fractures of the proximal third of ulna with dislocation of the radial head. Monteggia fractures much more commonly are seen in children than in adults, but the bilateral entity is rare in both age groups. The following case is about the course of treatment for bilateral Monteggia fractures in a young male. CASE REPORT A 35-year-old male came to the emergency with alleged history of roadside accident. Radiography showed bilateral Monteggia fracture type III (by the Bados classification). Surgical intervention was required with locking compression plates put on the both sides. Closed reduction of the radial head was done on both sides. The patient was given pop slabs for bilateral forearms for 21 days. After removing the splints, the function of the elbow was determined by the Broberg Morrey score which was on the right side 45 and on the left side 47 and 100 on both sides after 5 months of follow-up. CONCLUSION Surgical intervention and early rehabilitation are the most important and ideal line of treatment for the return of the good function of both elbows. Diagnosis, surgical technique, rehabilitation program, and clinical results are reported. The bilateral nature of the presentation does not affect the outcome of the fractures.
Collapse
Affiliation(s)
- Kavin Khatri
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab. India
| | - Karan Rajpal
- Department of Orthopaedics, Guru Gobind Singh Medical College, Faridkot, Punjab, India,Address of Correspondence: Dr. Karan Rajpal, Department of Orthopaedics, Guru Gobind Singh Medical College, Faridkot, Punjab, India. E-mail:
| | - Jagdeep Singh
- Department of Orthopaedics, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| |
Collapse
|
18
|
Cao YQ, Deng JZ, Zhang Y, Yuan XW, Liu T, Li J, Li X, Gou P, Li M, Liu X. Clinical effect of manual reduction of humeroradial joint in the treatment of type Ⅰ-Ⅲ fresh Monteggia fracture in children. Chin J Traumatol 2020; 23:233-7. [PMID: 32680703 DOI: 10.1016/j.cjtee.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the efficacy of closed reduction on the humeroradial joint in the treatment of Bado type Ⅰ, Ⅱ and Ⅲ fresh Monteggia fractures in children and investigate the effect of clinical factors, including Bado classification, age and time of treatment on the success rate of closed reduction. METHODS We retrospectively studied the data of children ≤10 years old with fresh Monteggia fractures (injury within two weeks) treated by manual reduction with plaster immobilization from January 2014 to April 2019. All patients were followed up in the outpatient department every two weeks for 4-6 weeks until plaster removal and then 3, 6 and 12 months. Online or telephone interview was provided for some inconvenient patients after 6 months. Mackay criteria were used to evaluate the clinical effect. Radiographic data were collected and reviewed to assess the reduction of the humeroradial joint. Function of the elbow joint and forearm was evaluated and risk factors related to the failure of reduction were assessed. The successful manual reduction was analyzed from three aspects, respectively Bado fracture type (Ⅰ, Ⅱ, Ⅲ), patient age (<3 year, 3-6 years, >6 years) and time interval from injury to treatment (group A, <1 day; group B, 1-3 days; group C, >3 days). RESULTS Altogether 88 patients were employed in this study, including 58 males (65.9%) and 30 females (34.1%) aged from 1 to 10 years. There were 29 cases (33.0%) of Bado type Ⅰ Monteggia fractures, 16 (18.2%) type Ⅱ and 43 (48.7%) type Ⅲ. Successful manual reduction was achieved in 79 children (89.8%) at the last follow-up. The failed 9 patients received open surgery. Mackay criteria showed 100% good-excellent rate for all the patients. The success rate of manual reduction was 89.7%, 87.5% and 90.7% in Bado type Ⅰ, Ⅱ and Ⅲ cases, respectively, revealing no significant differences among different Bado types (χ2 = 0.131, p = 0.937). Successful closed reduction was achieved in 13 toddlers (13/13, 100%), 38 preschool children (28/42, 90.5%) and 28 school-age children (28/33, 84.8%), suggesting no significant difference either (χ2 = 2.375, p = 0.305). However time interval from injury to treatment showed that patients treated within 3 days had a much higher rate of successful manual reduction: 67 cases (67/71, 94.4%) in group A, 10 cases (10/11, 90.9%) in group B, and 2 cases (2/6, 33.3%) in group C (χ2 = 22.464, p < 0.001). Fisher's test further showed significant differences between groups A and C (p = 0.001) and groups B and C (p = 0.028). CONCLUSION Closed reduction is a safe and effective method for treating fresh Monteggia fractures in children. The reduction should be conducted as soon as possible once the diagnosis has been made.
Collapse
|
19
|
Xu L, Ye W. Radial neck fracture or Monteggia equivalent lesion: delayed radial head subluxation in an adolescent and review of literature. BMC Musculoskelet Disord 2020; 21:282. [PMID: 32375718 PMCID: PMC7204043 DOI: 10.1186/s12891-020-03315-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/27/2020] [Indexed: 12/25/2022] Open
Abstract
Background Monteggia equivalent lesion represents a series of combined elbow and forearm injuries that resemble typical Monteggia fracture either in presentation or mechanism. The term has gradually evolved since its introduction, as sporadic case reports continued to complement it. The aim of this study was to present a furthermore type of that lesion which no previous study had reported and arouse pediatric orthopedists’ additional awareness of it. Case presentation A 11-year-old girl, whose injury pattern initially appeared to be a mild radial neck fracture with undisplaced proximal ulnar fracture, and without radial head dislocation, was treated with closed reduction and long-arm splint immobilization. Acceptable results were acquired at first-week follow-up, yet dramatic changes turned up 2 weeks later when the dislocated radial head was found. A further reduction to the fracture and joint site only resulted in a subluxated and incongruous radiocapitellar joint on the three-dimensional computed tomography (3D-CT). Then a definitive operation was performed, which involved a Boyd incision, correction of radial head tilting, opening wedge osteotomy of the proximal ulna and proper fixation respectively. And acceptable results were achieved 1 year later. Conclusions This case, with occult proximal ulna fracture, angulated radial neck fracture, subsequent radiocapitellar dislocation, and articular incongruity, was deemed as a rare Monteggia type-one equivalent fracture-dislocation variant rather than an ordinary radial neck fracture and it facilitates further understanding and management of the Monteggia fracture.
Collapse
Affiliation(s)
- Lujie Xu
- Department of Orthopaedics, Children's Hospital, Zhejiang University School of Medicine, 14th Floor, Inpatient Building, No. 3333 Binsheng Road, Hangzhou, Zhejiang, People's Republic of China.
| | - Wensong Ye
- Department of Orthopaedics, Children's Hospital, Zhejiang University School of Medicine, 14th Floor, Inpatient Building, No. 3333 Binsheng Road, Hangzhou, Zhejiang, People's Republic of China
| |
Collapse
|
20
|
Abstract
PURPOSE The 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). METHODS This 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. RESULTS No 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). CONCLUSION EF 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 EVIDENCE IV.
Collapse
Affiliation(s)
- Z. Yuan
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China
| | - H. W. Xu
- University Hospital Estaing, Department of Pediatric Surgery, Clermont Ferrand, France
| | - Y. Z. Liu
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China
| | - Y. Q. Li
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China
| | - J. C. Li
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China
| | - F. Canavese
- GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China,University Hospital Estaing, Department of Pediatric Surgery, Clermont Ferrand, France,Correspondence should be sent to F. Canavese, Department of Pediatric Orthopaedics, GuangZhou Women and Children’s Medical Center, 9th JinSui Road, GuangZhou, 510623, China. E-mail:
| |
Collapse
|
21
|
Biewener A, Bischoff F, Rischke T, Tille E, Nimtschke U, Kasten P, Schaser KD, Nowotny J. Instability of the proximal radioulnar joint in Monteggia fractures-an experimental study. J Orthop Surg Res 2019; 14:392. [PMID: 31779645 PMCID: PMC6883589 DOI: 10.1186/s13018-019-1367-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background A Monteggia fracture is defined as a fracture of the proximal ulna combined with a luxation of the radial head. The aim of the present work is to evaluate the extent of instability of the radius head in the proximal radioulnar joint (PRUJ) as a function of the severity of elbow fracture and ligamentous injury in an experimental biomechanical approach. Methods Eight fresh-frozen cadaver arms were used. All soft tissues were removed except for the ligamentous structures of the PRUJ and forearm. A tensile force of 40 N was exerted laterally, anteriorly or posteriorly onto the proximal radius. The dislocation in the PRUJ was photometrically recorded and measured by two independent examiners. After manual dissection of the ligamentous structures up to the interosseous membrane, the instability was documented and subsequently measured. The following dissection levels were differentiated: intact ligamentous structures, dissection of annular ligament, oblique cord and proximal third of interosseous membrane. Results An anterior instability remains relatively constant until the proximal third of the interosseous membrane is dissected. The radial head already dislocates relevantly in the posterior direction after dissection of the annular ligament with an additional considerable stability anteriorly and laterally. Subsequently, the posterior instability increases less pronouncedly in regard of distal resected structures. The lateral instability increases constantly during the progressing resection of the ligamentous structures. Conclusion On the one hand, a complete healing of the ligament injury after functional treatment is hardly conceivable with ligamentary damage up to the level of the proximal interosseous membrane. A remaining instability of the proximal radius could therefore be a possible cause for the unsatisfactory clinical results after certain Monteggia fractures. On the other hand, the present study may give a possible explanation (i.e. early dorsal radius head dislocation after dissection of annular ligament) why the Bado II injury is the most frequent type of Monteggia fractures.
Collapse
Affiliation(s)
- Achim Biewener
- Orthopaedic-Traumatology Centre (OUC), Carl Gustav Carus University, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Fabian Bischoff
- Orthopaedic-Traumatology Centre (OUC), Carl Gustav Carus University, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Tobias Rischke
- Orthopaedic-Traumatology Centre (OUC), Carl Gustav Carus University, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Eric Tille
- Orthopaedic-Traumatology Centre (OUC), Carl Gustav Carus University, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Ute Nimtschke
- Institute of Anatomy, Carl Gustav Carus University, Technical University Dresden, Dresden, Germany
| | | | - Klaus-Dieter Schaser
- Orthopaedic-Traumatology Centre (OUC), Carl Gustav Carus University, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,Centre for Translational Bone, Joint and Soft Tissue Research, Technical University Dresden, Dresden, Germany
| | - Jörg Nowotny
- Orthopaedic-Traumatology Centre (OUC), Carl Gustav Carus University, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany. .,Centre for Translational Bone, Joint and Soft Tissue Research, Technical University Dresden, Dresden, Germany.
| |
Collapse
|
22
|
Eden L, Frey SP, Gilbert F, Jordan MC, Fenwick A, Meffert RH. Anatomically shaped locking plates for radial head and olecranon fracture fixation in Monteggia-like lesions. Technol Health Care 2019; 28:193-201. [PMID: 31594272 DOI: 10.3233/thc-191812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Monteggia-like lesions are rare injuries. We retrospectively reviewed 40 consecutive patients with Monteggia-like lesions treated at a level I trauma center from 2009 to 2016. Clinical results were evaluated with a focus on the use of modern locking plates. OBJECTIVE AND METHODS Twenty-eight patients had Bado type II fractures, 11 had Bado type I, and 1 had Bado type III. All patients were treated by plate fixation of the ulna with a locking compression plate or double mini-plates. Fixation or replacement was performed for radial head fractures. We characterized all fractures and recorded the range of motion (ROM); 100-point visual analog scale (VAS) scores for pain and function; Disabilities of the Arm, Shoulder and Hand (DASH) score; and Mayo Elbow Performance Score (MEPS). A follow-up rate of 78% was reached at an average of 36 months (range, 12-95 months). RESULTS Stable fixation without recurrent instability was accomplished. The average ROM for flexion reached 130∘ with an extension deficit of 13∘. The sum of supination and pronation was 136∘. The VAS scores for pain and function were 20 and 75, respectively. The average MEPS and DASH scores were 84 and 28, respectively. Bado type I fractures had better outcomes for all variables, especially forearm rotation (p< 0.05). The complication rate was 22.5% and revision rate was 17.5%. CONCLUSION This fracture repair technique can safely achieve good and excellent outcomes in most cases and is partly superior to previously published techniques. However, Bado type II fractures still have a risk of poor results.
Collapse
Affiliation(s)
- Lars Eden
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany.,Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Sönke P Frey
- Department of Orthopedics and Trauma Surgery, St. Josef-Hospital Bochum, Katholisches Klinikum Bochum, Ruhr-University Bochum, Germany.,Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Fabian Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Martin C Jordan
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Annabel Fenwick
- Department of Trauma Surgery, Klinikum Augsburg, Augsburg, Germany
| | - Rainer H Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| |
Collapse
|
23
|
Shinohara D, Yasuda T, Arai M, Sato K, Arima T, Kanzaki K. A Long-standing Monteggia Fracture in a Child who underwent Bone Lengthening and Annular Ligament Reconstruction: A Case Report. J Orthop Case Rep 2019; 9:30-33. [PMID: 31559222 PMCID: PMC6742879 DOI: 10.13107/jocr.2250-0685.1406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Monteggia fractures are rare and account for 1% of all pediatric forearm fractures. Dislocation of the radial head with plastic deformation of the ulna is particularly rare and can be overlooked, thereby resulting in long effects. Here, we report the treatment of a case of a long-standing Monteggia fracture in a child. Case Report: A 6-year-old girl who was injured by a fall was examined by a local physician. 4 weeks later, she was referred to our hospital. Plain X-ray and computed tomography revealed a long-standing Monteggia fracture. Ulnar osteotomy was performed; however, complete realignment was not achieved. Scar tissue and the annular ligament remained intact, thereby hindering complete reduction. The scar tissue surrounding the radial head was surgically removed, and subluxation was reduced. The annular ligament was reconstructed, and the ulna was lengthened by external fixation. 1 year postoperatively, the patient’s elbow range of motion is good, and there has been no recurrence of radial head dislocation. Conclusions: The patient achieved good progress through the use of annular ligament reconstruction and ulnar osteotomy to straighten and anatomically realign the ulna. Post-operative repeat dislocation was avoided by reducing radial head dislocation, removing the scar tissue, and reconstructing the annular ligament.
Collapse
Affiliation(s)
- Daichi Shinohara
- DepartmentofOrthopaedics, Fujigaoka Hospital, Showa University School of Medicine, Yokohama, Japan
| | - Tomohiro Yasuda
- DepartmentofOrthopaedics, Fujigaoka Hospital, Showa University School of Medicine, Yokohama, Japan
| | - Masayuki Arai
- DepartmentofOrthopaedics, Fujigaoka Hospital, Showa University School of Medicine, Yokohama, Japan
| | - Kaoru Sato
- DepartmentofOrthopaedics, Fujigaoka Hospital, Showa University School of Medicine, Yokohama, Japan
| | - Toshihiko Arima
- DepartmentofOrthopaedics, Fujigaoka Hospital, Showa University School of Medicine, Yokohama, Japan
| | - Koji Kanzaki
- DepartmentofOrthopaedics, Fujigaoka Hospital, Showa University School of Medicine, Yokohama, Japan
| |
Collapse
|
24
|
Wang Q, Du MM, Pei XJ, Luo JZ, Li YZ, Liu YC, Wang X, Cao JC, Han JH. External Fixator-assisted Ulnar Osteotomy: A Novel Technique to Treat Missed Monteggia Fracture in Children. Orthop Surg 2019; 11:102-108. [PMID: 30714691 PMCID: PMC6430468 DOI: 10.1111/os.12426] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/26/2017] [Accepted: 01/28/2018] [Indexed: 11/30/2022] Open
Abstract
Objective The treatment of missed Monteggia fracture remains a challenge, despite the various surgical methods described. The purpose of this study was to explore a new surgical technique utilizing external fixator‐assisted ulnar osteotomy and to assess the surgical results in a case series. Methods Thirteen patients with missed Monteggia fractures were treated at our institution using this new surgical technique from August 2012 to January 2016. Our series included 11 boys and 2 girls. The left elbow was involved in 6 patients and the right elbow was involved in 7 patients. According to the Bado classification, 10 fractures were classified as Bado type I with anterior radial head dislocation and 3 were classified as Bado type III with anterolateral dislocation. The average age at the time of surgery was 5 years 8 months (range, 2 years 2 months–10 years). The mean trauma‐to‐surgery interval was 12 months (range, 2–36 months). All patients underwent ulnar osteotomy with angulation and lengthening using a temporary external fixator, plate fixation of the osteotomy, and open reduction of the radial head dislocation without annular ligament reconstruction. Results The average follow‐up was 27 months (range, 16–44 months). The average operation time was 175 min (range, 140–215 min). The average length of distraction was 0.7 cm (range, 0.5–1.2 cm) and the average angulation was 28° (range, 20°–30°) at the ulnar osteotomy site intraoperatively. The elbow performance score (Kim's) was excellent in 10 cases and good in 3 cases. No neurovascular complications, compartment syndrome or implant breakage occurred. No pain in the distal radioulnar joint or limited range of motion of the wrist occurred in any patient. The radial head remained reduced in all patients with no subluxation or redislocation. However, delayed ulnar union occurred in 3 cases, all of which were successfully treated with plaster cast immobilization within approximately 6 months postoperatively. One patient presented with cubitus valgus postoperatively with a carrying angle of 30°, which was 10° greater than the contralateral carrying angle. Conclusions External fixator‐assisted ulnar osteotomy offers substantial flexibility for achieving the optimal positioning of the transected ulna to reduce the radial head prior to the final ulnar osteotomy fixation with a plate, thereby facilitating an effective operative performance. Our procedure is a safe and effective method to treat missed pediatric Monteggia fractures.
Collapse
Affiliation(s)
- Qiang Wang
- Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Meng-Meng Du
- Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xin-Jian Pei
- Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jun-Zhong Luo
- Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya-Zhou Li
- Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yu-Chang Liu
- Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xuan Wang
- Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jin-Chao Cao
- Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiu-Hui Han
- Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
25
|
Abstract
Fractures of the proximal ulna range from simple olecranon fractures to complex Monteggia fractures or Monteggia-like lesions involving damage to stabilizing key structures of the elbow (i.e. coronoid process, radial head, collateral ligament complex). In complex fracture patterns a computerized tomography scan is essential to properly assess the injury severity. Exact preoperative planning for the surgical approach is vital to adequately address all fracture parts (base coronoid fragments first). The management of olecranon fractures primarily comprises tension-band wiring in simple fractures as a valid treatment option, but modern plate techniques, especially in comminuted or osteoporotic fracture types, can reduce implant failure and potential implant-related soft tissue irritation. For Monteggia injuries, the accurate anatomical restoration of ulnar alignment and dimensions is crucial to adjust the radiocapitellar joint. Caution is advised if the anteromedial facet (anatomical insertion of the medial collateral ligament) of the coronoid process is affected, to avoid posteromedial instability. Radial head reconstruction or replacement is essential in Monteggia-like lesions to restore normal elbow function. The postoperative rehabilitation programme should involve active elbow motion exercises without limitations as early as possible following surgery to avoid joint stiffness.
Cite this article: EFORT Open Rev 2019;4:1-9. DOI: 10.1302/2058-5241.4.180022.
Collapse
Affiliation(s)
- Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Arne Buchholz
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Karl F Braun
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| |
Collapse
|
26
|
Anshuman R, Aggarwal AN, pandey R, Mishra P, Yeptho P, Raj R. Type III monteggia equivalent injury with compartment syndrome in an 8 year old child: A case report. J Clin Orthop Trauma 2019; 10:800-803. [PMID: 31316259 PMCID: PMC6611976 DOI: 10.1016/j.jcot.2018.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/21/2018] [Indexed: 11/26/2022] Open
Abstract
A rare case of a type III Monteggia fracture equivalent with compartment syndrome is reported here. Literature is very scanty about this rare combination of injuries which we are discussing. Timely intervention can lead to a satisfactory outcome even in these complex injuries.
Collapse
|
27
|
Papaioannou I, Repantis T, Baikousis A, Korovessis P. Adult Monteggia Lesion with Ipsilateral Distal Radius Fracture: A Case Report and Review of the Literature. J Orthop Case Rep 2018; 8:77-80. [PMID: 30584524 PMCID: PMC6298714 DOI: 10.13107/jocr.2250-0685.1120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Monteggia lesion is a well-known injury that constitutes 0.7% of forearm fractures-dislocations. The combined presentation of Monteggia injury with ipsilateral distal radius fracture is an extremely rare lesion, especially in adults. Case Report: A 25-year-old woman fell from a chair, injuring her left forearm and wrist. On admission, plain roentgenograms of the left upper extremity revealed an anterior, Bado type-1 Monteggia fracture-dislocation associated with an ipsilateral distal radius fracture. The patient underwent surgical treatment of both injuries with a 3.5 limited contact dynamic compression plate for ulna and a 3.5 mm T-type buttress locking plate for distal radius. Intraoperative roentgenogram showed a spontaneous reduction of the ipsilateral dislocated radial head following osteosynthesis. An above, the elbow plaster cast was applied for 2 weeks because of the radial head dislocation. 10 weeks postoperatively the patient regained full range of motion of her wrist, elbow, and supination/pronation in her forearm. 4 months postoperatively she was returned to her previous daily activity after roentgenograms showed complete bone healing. Conclusion: In this rare case presentation with a review of the literature, we emphasize the mechanism of this lesion and we provide some risk factors for poor functional outcomes when treating such injuries. Both the review of the previous literature and our opinion support that rigid fixation of both fractures in such injuries is mandatory to achieve good functionality through early mobilization. Plain roentgenograms of the whole forearm including wrist and elbow are essential to avoid misdiagnosis.
Collapse
Affiliation(s)
- Ioannis Papaioannou
- Department of Orthopaedics, Spine and Trauma Unit, General Hospital of Patras, Greece
| | - Thomas Repantis
- Department of Orthopaedics, Spine and Trauma Unit, General Hospital of Patras, Greece
| | - Andreas Baikousis
- Department of Orthopaedics, Spine and Trauma Unit, General Hospital of Patras, Greece
| | - Panagiotis Korovessis
- Department of Orthopaedics, Spine and Trauma Unit, General Hospital of Patras, Greece
| |
Collapse
|
28
|
Posey SL, Cole HA, Halverson S, Stutz C, Schoenecker JG. Intra-articular Monteggia Fracture: A Case Study of Using the Center of Rotational Angulation to Improve a Functional Outcome. J Orthop Case Rep 2018; 8:27-30. [PMID: 30915288 PMCID: PMC6424305 DOI: 10.13107/jocr.2250-0685.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Elbow fractures are the most common pediatric fracture to require operative fixation and can be associated with significant morbidities such as vascular injury, neurologic injury, and loss of function. Specifically, the chronic Monteggia fracture-dislocation causes devastating losses in range of motion. Presenting as a proximal to midshaft ulna fracture and radiocapitellar joint disruption, the acute injury can be successfully managed with closed reduction, serial casting, and close follow-up. The chronic complications of this injury, however, usually occur from an unrecognized radial head dislocation. Here, we present the first known case of a chronic Monteggia fracture-dislocation in the setting of an intra-articular ulnar fracture. Using the center of rotational angulation (CORA) from injury mechanism and radiographs, an intra-articular osteotomy was performed to correct ulnar length and improve this child's range of motion. CASE REPORT A 3-year-old Hispanic male was first seen in the emergency department for elbow pain following a fall from a sofa. He was incorrectly diagnosed with an isolated intra-articular ulna fracture. 5 weeks after the initially missed Monteggia fracture-dislocation, he presented to clinic with 90° flexion, 40° extension, and a 20° pronation/supination arc. An opening-wedge osteotomy was performed at the intra-articular CORA to restore ulnar length and allow for reduction of the radial head. The magnitude of the ulnar opening-wedge osteotomy was trialed until the radiocapitellar joint maintained reduction throughout pronosupination. CONCLUSION 7 months after the surgery, the patient displayed functional improvements with 115° flexion, 15° extension, and a 75° pronation/supination arc. On physical examination, he had no neuropathic symptoms, with intact median, radial, and ulnar nerves. Using the CORA from the perceived injury mechanism and radiographs, an intra-articular osteotomy was performed to correct ulnar length, reduce the radial head, and thereby improve this child's range of motion.
Collapse
Affiliation(s)
- Samuel L Posey
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heather A Cole
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Schuyler Halverson
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chris Stutz
- Divisions of Hand and Pediatric Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX, USA
| | - Jonathan G Schoenecker
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
29
|
Liu QL, Zhang YB, Shi LY, Wang Q, Geng PS, Wang PL, Wang YS, Wang JX, Zeng X. [Meta analysis of surgical treatment for old Monteggia fracture in children]. Zhonghua Yi Xue Za Zhi 2018; 98:3096-3101. [PMID: 30392271 DOI: 10.3760/cma.j.issn.0376-2491.2018.38.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analysis the treatment effect of the ulnar osteotomy and ring-shaped ligament reconstruction for the treatment of old Monteggia fracture in children by using Meta analyze, and the difference of clinical curative effect was compared in order to provide the basis for the selection of clinical treatment options for old Monteggia fractures in children. Methods: We searched databases such as CNKI, Wanfang database, Medline, PubMed, Embase and Science through computer, at the same time, the references of relevant documents were retrieved manually, and the data processing was carried out by the RevMan5.3 statistical software provided by the Cochrane cooperation network by incorporating the exclusion criteria. The results were obtained and analyzed. Results: A total of 17 standard literature, 438 cases, 224 cases of ulnar osteotomy, 214 cases with ring ligament repair and reconstruction were obtained. The operation scheme, which was mainly based on the lengthening of ulna osteotomy, was superior to the reconstruction of ring ligament reconstruction. The complications and second operation rates of the former was less than that of the latter. Conclusion: The surgical methods for the reconstruction of the ulna osteotomy and the ring-shaped ligament have advantages and disadvantages. The choice of the operative plan for the old Monteggia fracture should be based on the following factors: the time of the old Monteggia fracture formation, the degree of the ulnar and radial deformity and the familiarity of the operative method.
Collapse
Affiliation(s)
- Q L Liu
- Department of Pediatric Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
The Monteggia injury is defined as radial head dislocation with a fracture of the ulnar shaft. This combination should be sought routinely in patients with ulnar fractures, even when the displacement is small. The emergent management is simple, as reducing the ulnar fracture is usually sufficient to stabilise the radial head. Internal fixation of the ulna deserves to be widely used to fully stabilise the radial head. Irreducibility of the radial head at the acute stage may indicate an interposition, which requires open surgery on the joint. Radial head dislocation may occur even with minimal displacement of the ulnar fragment. Chronic Monteggia fractures are more challenging to treat and their outcomes are more variable. The radial head becomes irreducible after 2 to 3 weeks. When a simple surgical approach fails to ensure stable reduction, the most widely used method at present is open reduction of the radial head and proximal osteotomy of the ulnar shaft. Stability must be obtained intra-operatively. Without treatment, radial head dislocation may be well tolerated for several months or even years. In the long term, however, osteoarticular remodelling results in loss of joint congruence, pain and, eventually, osteoarthritis. Radiographs must therefore be obtained on an emergency basis and analysed with great care to avoid missing a Monteggia fracture.
Collapse
Affiliation(s)
- M Delpont
- Service de chirurgie pédiatrique, hôpital Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
| | - D Louahem
- Service de chirurgie pédiatrique, hôpital Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - J Cottalorda
- Service de chirurgie pédiatrique, hôpital Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| |
Collapse
|
31
|
Hamaker M, Zheng A, Eglseder WA, Pensy RA. The Adult Monteggia Fracture: Patterns and Incidence of Annular Ligament Incarceration Among 121 Cases at a Single Institution Over 19 Years. J Hand Surg Am 2018; 43:85.e1-85.e6. [PMID: 28967445 DOI: 10.1016/j.jhsa.2017.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/19/2017] [Accepted: 08/14/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purposes of this study were to identify the relative frequency of Monteggia fracture patterns and to investigate the required frequency of open reduction of the proximal radiocapitellar joint. METHODS We identified 121 Monteggia fractures at a Level I trauma center from 1996 to 2015 and included 119 in this study. These fractures were identified using a database search for the appropriate International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes as well as individual surgeons' logs. Two fellowship-trained hand surgeons reviewed the identified patients' x-rays and operative notes. Each fracture was classified using Bado's original description, excluding transolecranon and Monteggia variants. RESULTS Bado I lesion represented 68% (81 of 119) of Monteggia fractures. Annular ligament incarceration preventing radial head reduction occurred in approximately 17% (14 of 81) of this Bado type. Revision fixation of the ulna was not necessary (none of 119 cases) and functional range of motion (average arc, 117°) was recovered in most patients. The reoperation rate of 20% (23 of 119) was related to the severity of the presenting injury and hardware prominence. CONCLUSIONS Most radial head dislocations associated with Monteggia fractures occur anteriorly and will reduce with anatomic plating of the ulna. In cases where the radial head fails to reduce, entrapment of the annular ligament can be expected and open reduction is required. Revision fixation of the ulna to achieve reduction of the radial head is uncommon in our experience. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
Affiliation(s)
- Max Hamaker
- University of Maryland School of Medicine, Baltimore, MD
| | - Amy Zheng
- University of Maryland School of Medicine, Baltimore, MD
| | | | - Raymond A Pensy
- Department of Orthopaedics, University of Maryland, Baltimore, MD.
| |
Collapse
|
32
|
Affiliation(s)
- Cary Tanner
- Sierra Pacific Orthopaedic Center, Fresno, CA, USA.,Department of Orthopaedic Surgery, University of California, San Francisco, Fresno, CA, USA
| | - Toby Johnson
- Sierra Pacific Orthopaedic Center, Fresno, CA, USA.,Department of Orthopaedic Surgery, University of California, San Francisco, Fresno, CA, USA
| | - Kourosh Kolahi
- Department of Orthopaedic Surgery, University of California, San Francisco, Fresno, CA, USA
| | - Lisa Husak
- Department of Orthopaedic Surgery, University of California, San Francisco, Fresno, CA, USA
| | - Nathan Hoekzema
- Department of Orthopaedic Surgery, University of California, San Francisco, Fresno, CA, USA
| |
Collapse
|
33
|
Abstract
The forearm unit consists of the radius and ulna, a complex and interrelated set of joints (distal radioulnar joint, proximal radioulnar joint) and the soft tissue stabilizers between the 3 bones. Distally, this is represented by the triangular fibrocartilage complex at the wrist, proximally by the annular ligament at the elbow, and in the forearm by the interosseous membrane. Disruptions in any of these structures may lead to forearm instability, with consequences at each of the remaining structures.
Collapse
Affiliation(s)
- Julie E Adams
- Department of Orthopedic Surgery, Mayo Clinic Health System, Austin, MN; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
| |
Collapse
|
34
|
Hackl M, Wegmann K, Ries C, Lappen S, Scaal M, Müller LP. Annular ligament reconstruction with the superficial head of the brachialis: surgical technique and biomechanical evaluation. Surg Radiol Anat 2017; 39:585-91. [PMID: 27822697 DOI: 10.1007/s00276-016-1774-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to perform biomechanical testing of annular ligament (AL) reconstruction using the superficial head of the brachialis tendon (SHBT) as a distally based tendon graft. We hypothesized that posterior translation of the radial head following AL reconstruction with an SHBT graft does not significantly differ from intact specimens. METHODS Six fresh-frozen elbow specimens were used. The stability of the radial head against posterior translation forces (30 N) was evaluated in 0°, 45°, 90° and 120° of elbow flexion. Posterior translation was obtained for the intact AL, the sectioned AL and the reconstructed AL. Cyclic loading (100 cycles) in 90° of elbow flexion was performed for the intact and the reconstructed AL. RESULTS Posterior translation of the radial head decreased during elbow flexion in native specimens. Sectioning of the AL significantly increased instability over the full range of motion. AL reconstruction with the SHBT restored the stability of the proximal radius but-other than the native AL-was not influenced by elbow flexion. In 120° of flexion the native AL provided significantly more stability when compared to the reconstructed AL. Cyclic loading did not provide significant differences between native and reconstructed specimens. CONCLUSIONS We provide a feasible technique for AL reconstruction using the SHBT. The biomechanical results obtained in this study confirm the efficacy of the procedure. AL reconstruction restores the stability of the proximal radius, yet it cannot fully mimic the complex features of the intact AL.
Collapse
|
35
|
Laun R, Wild M, Brosius L, Hakimi M. Monteggia-like lesions - treatment strategies and one-year results. GMS Interdiscip Plast Reconstr Surg DGPW 2015; 4:Doc13. [PMID: 26734535 PMCID: PMC4686841 DOI: 10.3205/iprs000072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: The eponym “Monteggia fracture” includes various patterns of complex fracture-dislocations of the proximal ulna and radius, which are not well defined yet. They are frequently described as Monteggia-like lesions or Monteggia equivalent injuries. Until today, these injury patterns have been reported rarely. The objective of this retrospective study was to better define patterns of injury and to document the short-term results of treatment with current fixation techniques. Methods: Ten patients with a Monteggia-like lesion were included in this study and clinical and radiological follow-up examinations at an average of 12.3 months after the trauma were performed. For clinical follow-up the Mayo Modified Wrist Score, the Mayo Elbow Performance Score, the functional rating index of Broberg and Morrey, and the DASH score were utilized. Results: Osteosynthesis of the ulna was performed using a proximally contoured or precontoured LCP (locking compression plate) in all patients. All patients had a fracture of the radial head. All patients with a Mason type III radial head fracture received a cemented bipolar radial head prosthesis. All Mason type II fractures were treated with open reduction and internal fixation using mini screws. In all Mason type I fractures the treatment of the radial head dislocation was by closed reduction. Associated coronoid fractures were stabilized with lag screws through the ulnar plate or with independent lag screws after reduction of the fracture. According to the aforementioned scoring systems good to excellent results could be achieved. Conclusions: Our findings demonstrate that good or excellent short-term results can be obtained if the injury is classified correctly and a standardized surgical treatment of all components of the injury is achieved. Further studies with larger patient populations and longer follow up periods are needed to evaluate long-term effectiveness of this treatment concept.
Collapse
Affiliation(s)
- Reinhold Laun
- Vivantes Klinikum Neukölln, Department of Orthopedic and Trauma Surgery, Berlin, Germany
| | - Michael Wild
- Klinikum Darmstadt, Department of Orthopedic, Trauma and Hand Surgery, Darmstadt, Germany
| | - Lars Brosius
- Vivantes Klinikum Am Urban, Department of Orthopedic, Trauma and Hand Surgery, Berlin, Germany
| | - Mohssen Hakimi
- Vivantes Klinikum Am Urban, Department of Orthopedic, Trauma and Hand Surgery, Berlin, Germany
| |
Collapse
|
36
|
El Abdi M, Bassinga J. Wrist disarticulation associated with Monteggia fracture. Pan Afr Med J 2015; 21:320. [PMID: 26587167 PMCID: PMC4633738 DOI: 10.11604/pamj.2015.21.320.6679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 06/22/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Monsef El Abdi
- Department of Orthopaedic Surgery «1», Military Hospital of Instruction Mohammed V, Rabat, Morocco
| | - Jonathan Bassinga
- Department of Orthopaedic Surgery «1», Military Hospital of Instruction Mohammed V, Rabat, Morocco
| |
Collapse
|
37
|
Affiliation(s)
- Redouane Ouakrim
- Service de Chirurgie Orthopédique et Traumatologique CHU Ibn Sina, Rabat, Maroc
| | | |
Collapse
|
38
|
Abstract
The Monteggia fracture is one of the pitfalls of conventional diagnosis of upper limb trauma. Through a retrospective study of 20 cases diagnosed at the Department of Orthopaedic Surgery and Traumatology, University Hospital Center, Ibn Sina, Mohamed V University, Rabat, Morocco, between 2010 and 2014, we have tried to do an update on the management of Monteggia fractures either at of paraclinical exams or the surgical management. We support the idea that the dislocation of the radial head should be sought systematically to any isolated fracture of the ulna, for not to miss fracture Monteggia authentic. Rehabilitation of the upper limb must be done as soon as possible.
Collapse
Affiliation(s)
- Aniss Chagou
- Department of Orthopaedic Surgery and Traumatology, University Hospital Center, Ibn Sina, Mohamed V University, Rabat, Morocco
| | - Abdelkarim Rhanim
- Department of Orthopaedic Surgery and Traumatology, University Hospital Center, Ibn Sina, Mohamed V University, Rabat, Morocco
| | - Mohammed Saleh Berrada
- Department of Orthopaedic Surgery and Traumatology, University Hospital Center, Ibn Sina, Mohamed V University, Rabat, Morocco
| |
Collapse
|
39
|
Abstract
The eponym Monteggia fracture dislocation originally referred to a fracture of the shaft of the ulna accompanied by anterior dislocation of the radial head that was described by Giovanni Battista Monteggia of Italy in 1814. Subsequently, a further classification system based on the direction of the radial head dislocation and associated fractures of the radius and ulna was proposed by Jose Luis Bado of Uruguay in 1958. This article investigates the evolution of treatment, classification, and outcomes of the Monteggia injury and sheds light on the lives and contributions of Monteggia and Bado.
Collapse
Affiliation(s)
- Shady A Rehim
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI; Department of Hand & Reconstructive Microsurgery, National University Health System, Singapore
| | - Mallory A Maynard
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI; Department of Hand & Reconstructive Microsurgery, National University Health System, Singapore
| | - Sandeep J Sebastin
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI; Department of Hand & Reconstructive Microsurgery, National University Health System, Singapore.
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI; Department of Hand & Reconstructive Microsurgery, National University Health System, Singapore
| |
Collapse
|
40
|
Giannicola G, Scacchi M, Sacchetti FM, Cinotti G. Clinical usefulness of proximal ulnar and radial fracture-dislocation comprehensive classification system (PURCCS): prospective study of 39 cases. J Shoulder Elbow Surg 2013; 22:1729-36. [PMID: 24129057 DOI: 10.1016/j.jse.2013.07.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/22/2013] [Accepted: 07/28/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Complex fracture-dislocations of the proximal ulna and radius represent a challenge even for expert orthopaedic surgeons. A new comprehensive classification, the proximal ulnar and radial fracture-dislocation comprehensive classification system (PURCCS), was recently proposed. The aim of this study was to analyze the clinical usefulness of this classification in a large series of patients. MATERIALS AND METHODS We studied 38 patients (39 elbows) with a mean age of 56 years. All patients were classified with the PURCCS by use of standard radiography, computed tomography, and intraoperative fluoroscopy. Surgical treatment was performed according to the PURCCS therapeutic algorithm. Patients were followed up for a mean of 23 months. The clinical evaluation was performed with the Mayo Elbow Performance Score and Index (MEPS and MEPI); the Disabilities of the Arm, Shoulder, and Hand (DASH) score; and the modified American Shoulder and Elbow Surgeons (m-ASES) score. RESULTS Each pattern of fracture-dislocation in our series finds its position within the PURCCS. At the last follow-up, the mean MEPS, DASH score, and m-ASES score were 91.2, 14.9, and 83.9, respectively. The mean extension, flexion, pronation, and supination were 19°, 136°, 81°, and 79°, respectively. According to the MEPI, 72%, 20%, and 8% of cases were rated excellent, good, and fair, respectively. Two patients with elbow stiffness underwent a reoperation, with final satisfactory results. CONCLUSION The PURCCS helps identify the main lesions of each injury pattern; the associated therapeutic algorithm helps select correct surgical strategies. This study showed that the clinical results were satisfactory in the majority of cases, with few major complications and reinterventions. The PURCCS is a comprehensive classification that may contribute to the surgical management of these difficult fracture-dislocations. LEVEL OF EVIDENCE Level IV, case series, treatment study.
Collapse
|
41
|
Haveri S, Jatti R, Putti BB. Surgical treatment of chronic Monteggia type I equivalent lesion in 11 year old: a rare case report. Eur J Orthop Surg Traumatol 2012; 22 Suppl 1:75-8. [PMID: 26662753 DOI: 10.1007/s00590-012-0961-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 02/01/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The treatment of an unrecognized Monteggia lesion continues to pose a therapeutic challenge, as evidenced by the variety of surgical techniques described. The purpose of this study is to report one such rare case and its surgical treatment. CASE REPORT Eleven-year-old girl presented to us with left elbow injury 6 weeks after fall. On examination, she had deformity and total restriction of elbow movements. X-ray showed upper third ulnar fracture with separation of radial head epiphysis suggesting Monteggia fracture type 1 equivalent. Ulnar osteotomy with plating and reduction of radial head separation with transcapitellar wire fixation was done. Above elbow cast given for 6 weeks. RESULTS At 1 year follow-up, patient had regained good range of motion of elbow and forearm with maintenance of radial head reduction. CONCLUSION This study stresses on the need of surgical treatment in treating chronic Monteggia fractures. In best hands, it gives excellent results.
Collapse
Affiliation(s)
- Sameer Haveri
- Department of Orthopaedics, JN Medical College/KLE's Dr Prabhakar Kore's Hospital and MRC, Belgaum, Karnataka, India.
| | - Ravi Jatti
- Department of Orthopaedics, JN Medical College/KLE's Dr Prabhakar Kore's Hospital and MRC, Belgaum, Karnataka, India
| | - B B Putti
- Department of Orthopaedics, JN Medical College/KLE's Dr Prabhakar Kore's Hospital and MRC, Belgaum, Karnataka, India
| |
Collapse
|