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Nieboer MJ, Cancio-Bello A, Mallett KE, Velasquez Garcia AR, Hidden KA, Yuan BJ, Morrey ME, Sanchez-Sotelo J, O'Driscoll SW, Barlow JD. Trans-ulnar fracture dislocations of the elbow: a systematic review and clarification of classification systems. J Shoulder Elbow Surg 2024; 33:975-983. [PMID: 38036255 DOI: 10.1016/j.jse.2023.10.014] [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: 08/11/2023] [Revised: 09/24/2023] [Accepted: 10/18/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Complex elbow dislocations in which the dorsal cortex of the ulna is fractured can be difficult to classify and therefore treat. These have variably been described as either Monteggia variant injuries or trans-olecranon fracture dislocations. Additionally, O'Driscoll et al classified coronoid fractures that exit the dorsal cortex of the ulna as "basal coronoid, subtype 2" fractures. The Mayo classification of trans-ulnar fracture dislocations categorizes these injuries in 3 types according to what the coronoid remains attached to: trans-olecranon fracture dislocations, Monteggia variant fracture dislocations, and trans-ulnar basal coronoid fracture dislocations. The purpose of this study was to evaluate the outcomes of these injury patterns as reported in the literature. Our hypothesis was that trans-ulnar basal coronoid fracture dislocations would have a worse prognosis. MATERIALS AND METHODS We conducted a systematic review to identify studies with trans-ulnar fracture dislocations that had documentation of associated coronoid injuries. A literature search identified 16 qualifying studies with 296 fractures. Elbows presenting with basal subtype 2 or Regan/Morrey III coronoid fractures and Jupiter IIA and IID injuries were classified as trans-ulnar basal coronoid fractures. Patients with trans-olecranon or Monteggia fractures were classified as such if the coronoid was not fractured or an associated coronoid fracture had been classified as O'Driscoll tip, anteromedial facet, basal subtype I, or Regan Morrey I/II. RESULTS The 296 fractures reviewed were classified as trans-olecranon in 44 elbows, Monteggia variant in 82 elbows, and trans-ulnar basal coronoid fracture dislocations in 170 elbows. Higher rates of complications and reoperations were reported for trans-ulnar basal coronoid injuries (40%, 25%) compared to trans-olecranon (11%, 18%) and Monteggia variant injuries (25%, 13%). The mean flexion-extension arc for basal coronoid fractures was 106° compared to 117° for Monteggia (P < .01) and 121° for trans-olecranon injuries (P = .02). The mean Mayo Elbow Performance Score was 84 points for trans-ulnar basal coronoid, 91 for Monteggia (P < .01), and 93 for trans-olecranon fracture dislocations (P < .05). Disabilities of the Arm, Shoulder and Hand and American Shoulder and Elbow Surgeons scores were 22 and 80 for trans-ulnar basal coronoid, respectively, compared to 23 and 89 for trans-olecranon fractures. American Shoulder and Elbow Surgeons was not available for any Monteggia injuries, but the mean Disabilities of the Arm, Shoulder and Hand was 13. DISCUSSION Trans-ulnar basal coronoid fracture dislocations are associated with inferior patient reported outcome measures, decreased range of motion, and increased complication rates compared to trans-olecranon or Monteggia variant fracture dislocations. Further research is needed to determine the most appropriate treatment for this difficult injury pattern.
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Affiliation(s)
- Micah J Nieboer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ausberto R Velasquez Garcia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Clinica Universidad de los Andes, Santiago, Chile
| | - Krystin A Hidden
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brandon J Yuan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Gonzalez L, Littlefield C, Johnson J, Leucht P, Konda S, Egol K. Coronoid Fragment Size in Monteggia Fractures Predicts Ultimate Function. Orthopedics 2024; 47:15-21. [PMID: 37561103 DOI: 10.3928/01477447-20230804-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
We sought to determine what effect the size of a displaced coronoid fracture fragment in Monteggia injuries has on clinical outcome. Sixty-seven patients presented to an academic medical center for operative fixation of a Monteggia fracture. Radiographs were assessed for length and height of the displaced coronoid fragment using measuring tools in our center's imaging archive system. Data were analyzed using binary logistic or linear regression, as appropriate, controlling for sex, age, and Charlson Comorbidity Index. Outcome measurements included radiographic healing, range of motion, postoperative complications, and reoperation. The cohort had a mean follow-up of 16.7 months. Mean coronoid fragment area was 362.4±155.9 mm2. Elbow range of motion decreased by 3.8° of elbow flexion (P<.001), 3.3° of elbow extension (P<.001), and 3.8° of forearm supination (P=.007) for every 1-cm2 increase in coronoid fragment area. Complications (P=.012) and reoperation (P=.036) were associated with increasing coronoid fragment area. Nonunion rate, nerve injury, and pronation range of motion were not correlated to increasing coronoid fracture fragment area (P=.777, P=.123, and P=.351, respectively). As displaced coronoid fragment size increases in Monteggia fracture patterns, elbow range of motion decreases linearly. Coronoid displacement was also associated with increased rates of postoperative complication and need for reoperation. [Orthopedics. 2024;47(1):15-21.].
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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.
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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
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Loose O, Morrison SG, Langendoerfer M, Eberhardt O, Wirth T, Fernandez FF. Radial head distalisation with an external ring fixator as a therapy option in children with chronic posttraumatic radiocapitellar dislocations. Eur J Trauma Emerg Surg 2023; 49:1803-1810. [PMID: 36422659 DOI: 10.1007/s00068-022-02173-w] [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] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Missed monteggia-type injuries in children can result in chronic radial head dislocation with anatomic changes and osteoarticular remodeling of the radial head. In later stages, joint reconstruction is impossible and a functional radial head distalization can be a therapy option in symptomatic patients. METHODS From 2010 to 2018, 46 patients (18 female and 28 male, mean age 11.8 (4-20)) with chronic radius head dislocation treated in our institution were retrospectively analyzed. A radial head distalization was performed in symptomatic patients at the time of ulna lengthening and angulation by use of an external ring fixator. We analyzed the surgical and radiographic data as well as the clinical outcome of the patients measured by DASH and Mayo Elbow score. RESULTS 16 patients (6 female, 10 male) fulfilled the criteria for functional radial head distalization. Main reason was Monteggia injury in 11 cases, and radial head fracture in 5 cases. Average follow-up was 5.1 years (range 1-9, SD 2.1). Mean time from injury was 4.14 years (range: 4 months to 12 years, SD 3.5 years). Mean duration of external fixation was 106 days (range 56-182, SD 31.2), lengthening was 21.3 mm (range 12-42, SD 8.8). Average degree of sagittal angulation 14.8° (0-32°, SD 10.7°), coronal angulation 4.4° (0-25°, SD 7.3°). DASH score showed a good result with 2.4, and the MAYO Elbow Score was excellent (95/100). No secondary luxation of the radius head was detected. CONCLUSION Radial head distalization with external ring fixator can be a therapy option for chronic radius head dislocations in symptomatic patients without losing stability of the elbow joint in contrast to radial head resection.
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Affiliation(s)
- O Loose
- Department of Orthopedics, Olga Hospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Germany.
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
| | - S G Morrison
- Department of Orthopedics, The Royal Children's Hospital, Parkville, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - M Langendoerfer
- Department of Orthopedics, Olga Hospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Germany
| | - O Eberhardt
- Department of Orthopedics, Olga Hospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Germany
| | - T Wirth
- Department of Orthopedics, Olga Hospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Germany
| | - F F Fernandez
- Department of Orthopedics, Olga Hospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Germany
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Roper B, Parikh S, Haidar L, Warth R, Ambrose C, Younas S, Crawford L, Mansour A. Outcomes After Operative Treatment of Pediatric Monteggia Fracture-Dislocations: Comparison Between Open and Closed Injuries. J Pediatr Orthop 2022; 42:361-366. [PMID: 35543603 DOI: 10.1097/bpo.0000000000002171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Open pediatric Monteggia fracture-dislocations are a relatively uncommon injury pattern, with limited numbers reported in previous series. Open fracture-dislocations frequently represent more severe injury patterns with potential for contamination. We aim to determine differences in long-term clinical and functional outcomes in the operative management of closed versus open pediatric Monteggia fracture-dislocations. METHODS A retrospective review of operatively treated pediatric Monteggia fracture-dislocations was performed. Closed versus open injuries were compared in both clinical outcomes, as well as patient-reported outcomes through Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. RESULTS Of 30 operatively treated injuries, 12/30 (40%) were open fracture-dislocations. Patients were followed clinically for an average of 15.65 months in open injuries and an average of 4.61 months in closed injuries. A trend toward increased time to union was observed, however, significance was not achieved; open injuries averaged 8.0 versus 5.8 weeks for closed injuries ( P =0.07). Two patients (11%) in the closed fracture group experienced postoperative complications; both were minor. Five patients (42%) in the open fracture-dislocation group experienced a total of 6 postoperative complications; 5 of the 6 complications were major. QuickDASH scores were obtained at an average of 5 years postoperatively; mean QuickDASH scores were higher in the open fracture group, 13.1, compared with the closed fracture group, 5.9 ( P =0.038). Increased QuickDASH scores were independently associated with presence of postoperative complications. QuickDASH score could be expected to increase by 12.5 points in those with major complications ( P =0.044). CONCLUSION We present the largest single cohort of pediatric open Monteggia fracture-dislocation injuries to date. These injuries are predictive of poorer outcomes including trend toward increased time to union, increased risk of major complication, and can independently predict worse long-term patient-reported functional outcomes. LEVEL OF EVIDENCE Level III-these data represent a retrospective comparative study of clinical and functional outcomes.
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Affiliation(s)
- Brennan Roper
- Department of Orthopedic Surgery, University of Texas, Houston, TX
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Maszke M, Buchcic P, Marciniak M, Lebiedziński R, Lipiński Ł, Grzegorzewski A. Pediatric Monteggia Fracture Outcome Assessment - Preliminary Report. Ortop Traumatol Rehabil 2022; 24:79-86. [PMID: 35550359 DOI: 10.5604/01.3001.0015.8265] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The term Monteggia fracture refers to a class of injuries encompassing the fracture of the proximal end of the ulna with subluxation or dislocation of the radial head. These injuries account for 0.4-1% of all forearm fractures in children. Despite its low incidence, Monteggia fractures require particular attention, since as much as 30-50% of the cases may be unrecognized, which subsequently leads to complications. The purpose of this paper is to evaluate treatment outcomes of Monteggia fractures in children. Both conservative treatment and surgery were analyzed. MATERIAL AND METHODS 15 children (7 boys and 8 girls) between the ages of 4-16.3 years (mean age 8.3 years) with Monteggia fractures were hospitalized at our center in the years 2015-2020. Closed reduction and immobilization in a cast were performed in 12 patients, while three children underwent surgical treatment with internal fixation of the ulna. The radial head dislocation was reduced successfully in every patient. RESULTS Every child from the study group who received conservative treatment regained full elbow mobility as well as normal forearm supination and pronation. Only one of the patients who underwent the surgery demonstrated a 20° deficit in elbow flexion that did not affect limb function. CONCLUSIONS 1. Our experience shows that closed reduction together with immobilization in a cast is usually a sufficient treatment in Monteggia fractures. 2. However, the dislocated radial head should be properly reduced in all patients. 3. Correct diagnosis and treatment followed by appropriate rehabilitation result in full recovery and no mobility limitations in children and teenagers.
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Affiliation(s)
- Marcin Maszke
- Klinika Ortopedii i Ortopedii Dziecięcej, Centralny Szpital Kliniczny Uniwersytetu Medycznego w Łodzi, Polska / Orthopedics and Pediatric Orthopedics Department, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Piotr Buchcic
- Klinika Ortopedii i Ortopedii Dziecięcej, Centralny Szpital Kliniczny Uniwersytetu Medycznego w Łodzi, Polska / Orthopedics and Pediatric Orthopedics Department, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Marek Marciniak
- Klinika Ortopedii i Ortopedii Dziecięcej, Centralny Szpital Kliniczny Uniwersytetu Medycznego w Łodzi, Polska / Orthopedics and Pediatric Orthopedics Department, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Radosław Lebiedziński
- Klinika Ortopedii i Ortopedii Dziecięcej, Centralny Szpital Kliniczny Uniwersytetu Medycznego w Łodzi, Polska / Orthopedics and Pediatric Orthopedics Department, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Łukasz Lipiński
- Klinika Ortopedii i Ortopedii Dziecięcej, Centralny Szpital Kliniczny Uniwersytetu Medycznego w Łodzi, Polska / Orthopedics and Pediatric Orthopedics Department, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Andrzej Grzegorzewski
- Klinika Ortopedii i Ortopedii Dziecięcej, Centralny Szpital Kliniczny Uniwersytetu Medycznego w Łodzi, Polska / Orthopedics and Pediatric Orthopedics Department, Central Teaching Hospital of the Medical University of Lodz, Poland
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Hayami N, Omokawa S, Iida A, Kira T, Moritomo H, Mahakkanukrauh P, Kraisarin J, Shimizu T, Kawamura K, Tanaka Y. Effect of soft tissue injury and ulnar angulation on radial head instability in a Bado type I Monteggia fracture model. Medicine (Baltimore) 2019; 98:e17728. [PMID: 31689815 PMCID: PMC6946299 DOI: 10.1097/md.0000000000017728] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The effects of soft tissue damage and ulnar angulation deformity on radial head instability in Monteggia fractures are unclear. We tested the hypothesis that radial head instability correlates with the magnitude of ulnar angular deformity and the degree of proximal forearm soft tissue injury in Bado type I Monteggia fractures.We performed a biomechanical study in 6 fresh-frozen cadaveric upper extremities. Monteggia fractures were simulated by anterior ulnar angulation osteotomy and sequential sectioning of ligamentous structures. We measured radial head displacement during passive mobility testing in pronation, supination, and neutral rotation using an electromagnetic tracking device. Measurements at various ligament sectioning stages and ulnar angulation substages were statistically compared with those in the intact elbow.Radial head displacement increased with sequential ligament sectioning and increased proportionally with the degree of anterior ulnar angulation. Annular ligament sectioning resulted in a significant increase in displacement only in pronation (P < .05). When the anterior ulnar deformity was reproduced, the radial head displaced least in supination. The addition of proximal interosseous membrane sectioning significantly increased the radial head displacement in supination (P < .05), regardless of the degree of anterior ulnar angulation.Our Monteggia fracture model showed that radial head instability is influenced by the degree of soft tissue damage and ulnar angulation. Annular ligament injury combined with a minimal (5°) ulnar deformity may cause elbow instability, especially in pronation. The proximal interosseous membrane contributes to radial head stability in supination, regardless of ulnar angulation, and proximal interosseous membrane injury led to significant radial head instability in supination.
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Affiliation(s)
| | - Shohei Omokawa
- Department of Hand Surgery, Nara Medical University, Kashihara, Nara
| | | | | | - Hisao Moritomo
- Department of Physiotherapy, Osaka Yukioka College of Health Science, Ibaraki, Osaka, Japan
| | - Pasuk Mahakkanukrauh
- Excellence in Osteology Research and Training Center (ORTC)
- Department of Anatomy
| | - Jirachart Kraisarin
- Department of Orthopedic Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Zhang Y, Xiao W, Li J. A very rare presentation of reoperation combined both old Monteggia fracture and secondary distal radioulnar joint dislocation in adult: A case report. Medicine (Baltimore) 2019; 98:e15310. [PMID: 31008984 PMCID: PMC6494213 DOI: 10.1097/md.0000000000015310] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The old Monteggia fracture is an uncommon lesion pattern in adult, which may lead to the potential complications such as recurrent dislocation of the radial head, heterotopic ossification of the elbow, nerve palsy, malunion of the ulna, and residual forearm deformity. However, the secondary distal radioulnar joint (DRUJ) dislocation is rarely reported in the similar lesion. Here we present a unique reoperation of old Monteggia fracture combined with secondary DRUJ disruption after the initial operation failure. PATIENT CONCERNS A 38-year-old male presented to our hospital outpatient office complaining of left elbow stiffness and ongoing wrist dysfunction with a history of injury to the left forearm caused by a forklift accident that occurred 5 months previously. DIAGNOSIS AND INTERVENTIONS At the local hospital, the patient underwent successively fasciotomy and decompression, ulnar open reduction, and internal fixation due to osteofascial compartment syndrome and a misdiagnosed ulnar fracture. Upon examination, the secondary dorsal dislocation of the DRUJ was obvious both clinically and radiographically. We performed a revision surgery called ulnar osteotomy, radioulnar ligament repair, and temporary fixation of the DRUJ with a Kirschner wire. OUTCOMES The patient received a satisfactory result without observed redislocation and relapse according to the 1-year follow-up. LESSONS Considering the notoriously poor outcomes, the importance of early recognition and accurate treatment should be emphasized repeatedly in similar lesions. Paying close and continuous attention to the clinical and radiographic examinations of the elbow and wrist joint is necessary to avoid misdiagnosis and missed diagnosis.
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Affiliation(s)
- Yanchao Zhang
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
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9
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Kozin SH, Abzug JM, Safier S, Herman MJ. Complications of pediatric elbow dislocations and monteggia fracture-dislocations. Instr Course Lect 2015; 64:493-498. [PMID: 25745932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pediatric elbow dislocations and Monteggia lesions are prone to acute and chronic complications. A pediatric patient's cartilaginous and unossified distal humerus contributes to the risks of inaccurate diagnoses resulting from the misinterpretation of findings on plain radiographs. The debate continues regarding the amount of acceptable displacement for medial epicondyle fractures. In contrast, the radial head should always point directly to the capitellum. Chronic complications include instability and arthritis. Instability, which can be subtle and difficult to diagnose, can occur in the medial or the posterolateral direction, depending on the injured stabilizer. Restoration of stability remains the mainstay of treatment. Pediatric traumatic arthritis is extremely difficult to manage with surgery because of the limited number of reliable treatment options.
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Affiliation(s)
- Scott H Kozin
- Chief of Staff, Shriners Hospital for Children, Philadelphia, Pennsylvania
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Jochymek J, Straka M, Skvařil J, Plánka M. [Treatment of sequelae after Monteggia lesions in childhood]. Acta Chir Orthop Traumatol Cech 2012; 79:48-51. [PMID: 22405549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE OF THE STUDY To review the current methods of operative management of post-traumatic chronic radial head dislocation in chronic Monteggia lesions in children. MATERIAL AND METHODS Post-traumatic chronic dislocation of the proximal radius usually occurs following missed or ineffectively treated Monteggia fractures. The radial head is usually dislocated anteriorly. We performed open reduction of the radial head, reconstruction of the annular ligament and corrective osteotomy of the ulna in eleven patients. Three of our patients underwent ulnar lengthening via gradual distraction using an Ilizarov external fixator. This procedure was used in nine boys and five girls who were treated for complications following Monteggia lesions between 2000 and 2009. The average age at the time of surgery was 8 years and 4 months, the average injury-to-surgery interval was 19 months, and a prerequisite for surgery was a normal concave articular surface of the proximal radius. The patients were followed up for an average of 28 months and, at final follow-up, all were fully active and had no pain or instability. RESULTS The complications included: non-union of the ulnar osteotomy site in two patients, residual radiocapitellar subluxation in two patients, and one patient had revision surgery. Nine patients showed a full range of motion, two had a loss of extension, and three had a mean loss of pronation of 20 degrees and a mean loss of supination of 20 degrees. DISCUSSION The Monteggia lesion is a rare fracture in childhood, but its sequelae can be serious. So far a unified therapeutic approach has not been proposed. Most authors prefer reconstruction surgery. Our results are in full agreement with the published data. CONCLUSIONS The operative treatment of consequences after Monteggia fractures in children has a relatively high rate of complications and unpredictable results. Indications for reconstruction involve a normal articular surface of the radial head and a normal alignment of the radius and ulna. Key words: Monteggia fracture, consequences, reconstruction surgery, childhood.
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Affiliation(s)
- J Jochymek
- Klinika dětské chirurgie, ortopedie a traumatologie FN Brno a LF MU v Brně
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11
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Stein JA, Murthi AM. Reconstruction of a chronic Monteggia fracture with associated radioulnar synostosis. Am J Orthop (Belle Mead NJ) 2010; 39:E36-E38. [PMID: 20512175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Patients with multiple traumatic injuries can be difficult to treat, especially when a head injury is involved. In these cases, orthopedic injuries can be missed or ignored. In patients who recover, the orthopedic injuries can be more difficult to manage at a later date. We report the case of a patient whose Monteggia fracture was unmanaged while his head injury was addressed, resulting in a malunited ulna, chronically dislocated radial head, and radioulnar synostosis.
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Affiliation(s)
- Jason A Stein
- Shoulder and Elbow Service, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland 21207, USA
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12
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Fayaz HC, Jupiter JB. Monteggia fractures in adults. Acta Chir Orthop Traumatol Cech 2010; 77:457-462. [PMID: 21223824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Over the past fifty years, treatment outcomes of traumatic injuries in the upper limb have improved with the advent of better implants. However, the Monteggia fracture is often still associated with various complications, poor functional outcomes and a relatively high rate of revision surgeries. Rigid anatomic fixation of ulnar fracture is paramount. Open relocation of the radial head and soft tissue procedures are redundant. Monteggia fractures are challenging to treat. Critical analysis with respect to the high rate of complications and unsatisfactory functional outcomes is required. The type of fracture and associated injuries such as coronoid fracture and radial head fracture appear to influence the outcome in most cases. Negative prognostic factors such as prolonged immobilization, associated coronoid and radial head fractures must be minimized and treated appropriately. Prior to surgery the patient should be informed regarding the possible risk of residual functional limitations and the potential need for further revision surgeries.
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Affiliation(s)
- H C Fayaz
- Hand and Upper Extremity Service, Massachusetts General Hospital, Orthopaedic Surgery Harvard Medical School, Boston, Massachusetts, USA
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13
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Dattani R, Patnaik S, Kantak A, Lal M. Distal humerus lateral condyle fracture and Monteggia lesion in a 3-year old child: a case report. Acta Orthop Belg 2008; 74:542-545. [PMID: 18811042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We describe a case of a Monteggia fracture dislocation and an ipsilateral lateral humeral condyle fracture in a 3-year-old child. This is a rare combination of injuries with no previously reported cases in the literature. This case emphasises that when a fracture is detected around an elbow there should be a high index of suspicion for other injuries in the region.
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14
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Kontakis GM, Pasku D, Pagkalos J, Katonis PG. The natural history of a mistreated ipsilateral Galeazzi and Monteggia lesion: report of a case 39 years post-injury. Acta Orthop Belg 2008; 74:546-549. [PMID: 18811043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Galeazzi injury combined with ipsilateral Monteggia lesion is extremely rare. A 45-year-old male patient with a mistreated Galeazzi lesion combined with an ipsilateral Monteggia fracture at the age of 6 is presented. Thirty-nine years post-injury his elbow was asymptomatic and stable and his distal radioulnar and radiocarpal joints were also asymptomatic. The strength of the limb was equal to the unaffected contralateral upper limb and he was able to work manually as a waiter for the last 20 years without any problem. The only obvious defect was a 30 degrees lack of elbow flexion and a 10 degrees lack of forearm pronation in comparison to the normal side.
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15
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Rouhani AR, Navali AM, Sadegpoor AR, Soleimanpoor J, Ansari M. Monteggia lesion and ipsilateral humeral supracondylar and distal radial fractures in a young girl. Saudi Med J 2007; 28:1127-8. [PMID: 17603726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Ipsilateral supracondylar humeral and forearm fractures are uncommon in children. We present an unusual case of a 4-year-old girl with an ipsilateral supracondylar humeral fracture, Monteggia lesion, and distal metaphyseal radial fracture. Our management consisted of closed reduction and immobilization with plaster splint. The patient had an excellent result and full function.
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Affiliation(s)
- Ali R Rouhani
- Department of Orthopedic Surgery, Shohada Hospital, Tabriz University of Medical Sciences & Health Services, Tabriz, Iran.
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16
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Nanno M, Sawaizumi T, Ito H. Three cases of pediatric Monteggia fracture-dislocation associated with acute plastic bowing of the ulna. Am J Orthop (Belle Mead NJ) 2007; 36:E80-2. [PMID: 17657321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Mitsuhiko Nanno
- Department of Orthopaedic Surgery, Nippon Medical School, Musashikosugi Hospital, Kawasaki, Japan.
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17
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Prassinos NN. Fractures combination of the proximal antebrachium in an immature dog that resembles Monteggia fracture. Vet Comp Orthop Traumatol 2006; 19:184-6. [PMID: 16972002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A 5-month-old German shepherd dog with a combination of a proximal radial physeal fracture and a proximal ulnar diaphyseal comminuted fracture, with cranial displacement of their distal fragment, was presented. This fractures combination resembles type I Monteggia fracture. After surgical reduction of the fractures, three full-cerclage wires were used to stabilize the ulnar fracture, and two positional screws were placed across the radius and ulna immediately distally to the growth plate to hold these bones in apposition. Four weeks post-operatively, the screws were removed since sufficient callus had been formed and the dog was free of lameness. It seems that if the appropriate conditions for a type I Monteggia fracture develop in an immature dog, proximal radial physeal fracture instead of radial head luxation may accompany ulnar diaphyseal fracture.
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Affiliation(s)
- N N Prassinos
- Clinic of Surgery, Veterinary School, University of Thessaly, Karditsa, Greece.
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18
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Ruchelsman DE, Klugman JA, Madan SS, Chorney GS. Anterior dislocation of the radial head with fractures of the olecranon and radial neck in a young child: a Monteggia equivalent fracture-dislocation variant. J Orthop Trauma 2005; 19:425-8. [PMID: 16003205 DOI: 10.1097/01.bot.0000177389.43178.e2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We present a case of a type I Monteggia equivalent lesion in a 7-year-old child consisting of anterior dislocation of the radial head, radial neck fracture, and a fracture of the olecranon without an associated fracture of the ulnar diaphysis or metaphysis. After a review of the literature, we report this fracture pattern as a rare type I Monteggia equivalent fracture-dislocation variant. This report describes delayed surgical treatment and outcome after close follow-up of a rare type I Monteggia equivalent lesion. Diagnostic challenges with and treatment options for pediatric Monteggia equivalent fracture-dislocations are discussed.
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Affiliation(s)
- David E Ruchelsman
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases Orthopaedic Institute, New York, NY 10003, USA
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19
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Abstract
OBJECTIVE To evaluate the results of open reduction and ulnar osteotomy on missed Monteggia fractures in children. DESIGN Retrospective review. SETTING Tertiary care center orthopaedic hospital in Pellenberg, Belgium. PATIENTS/PARTICIPANTS Six children between 2 and 6 years old who sustained a Monteggia fracture that was initially missed were treated at our institute. They presented in our hospital 5 to 59 weeks postinjury. INTERVENTION Open reduction of the radial head was performed, combined with a dorsal opening wedge osteotomy of the proximal ulna and fixation with plate and screws. MAIN OUTCOME MEASUREMENTS Mobility of the elbow was measured by an independent observer, evaluating flexion-extension and pronation-supination preoperatively and postoperatively. RESULTS All patients regained a normal range of motion, the radial head remained relocated, and the axis of the forearm remained normal. CONCLUSION This operation-open reduction of the radial head and osteotomy of the ulna-results in an excellent outcome for a missed Monteggia fracture in children.
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Affiliation(s)
- I Degreef
- Orthopedic Department, University Hospital Pellenberg, Pellenberg, Belgium
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20
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Jiang XY, Zhang LD, Liu XH, Huang L, Wei J, Wang MY, Rong GW. [Hinged external fixator in elbow trauma management]. Zhonghua Wai Ke Za Zhi 2004; 42:737-40. [PMID: 15329235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To introduce a new way of treatment for elbow stiffness and instability. METHODS 30 cases of elbow trauma were treated with mobile hinged Orthofix elbow fixator, 26 of them were followed up. There are 15 male patients and 11 female patients. The average age is 32.6 years old. The 26 injured elbows involved 12 cases on left side and 14 cases on right side; Sixteen cases on the dominant side and 10 cases on the non-dominant side. Sixteen cases had elbow stiffness, 5 cases had acute radial head fracture and posterior dislocation of the elbow, 3 of cases had Monteggia's fracture dislocation, and 2 cases had neglected posterior dislocation of the elbow. RESULTS The average follow up time was 6 months (3 - 12 month). The mean time of fixation with fixator was 8.5 weeks (6 - 11 weeks). The mean ROM of the 16 cases of elbow stiffness was (37.5 +/- 0.8) degrees before operation, and (96.5 +/- 0.6) degrees operation, with a significant difference (P < 0.05). The mean Mayo elbow score was (69.5 +/- 1.7) before operation, compared with (82.8 +/- 1.6) after operation, with a significant difference (< 0.05). For the other 10 cases (5 cases with acute radial head fracture and posterior dislocation of the elbow, 3 cases with Monteggia's fracture dislocation, 2 cases with neglected posterior dislocation of the elbow), the average ROM of the elbow flexion-extension was 95 degrees (65 degrees - 150 degrees ); The average range of flexion was 117 degrees; the average loss of extension was 22 degrees; the average pronation was 76 degrees (20 degrees - 90 degrees ), the average supination was 75 degrees (15 degrees - 90 degrees ). Nine of the cases achieved anatomic reduction and proved by X-ray. The mean Mayo elbow score was 84 (49 - 96). Three cases were rated excellent, 4 good, 2 fair and 1 poor. The rate of excellent and good was 70% (7/10). Nine cases had no pain or mild pain, and did not need analgesic. Eight cases returned to their former work, 5 of the cases had complications. CONCLUSIONS The mobile hinged elbow external fixator have following advantages: (1) distraction of the articular space and enhance fracture healing; (2) allow early movement of the elbow during healing; (3) provide stable environment for the healing after arthrolysis and reconstruction. Mobile hinged elbow external fixator can achieve successful result in the treatment of elbow stiffness or unstable fracture dislocation of elbow.
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Affiliation(s)
- Xie-Yuan Jiang
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China
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21
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Abstract
Two to 13% of supracondylar humerus fractures in children are associated with an ipsilateral forearm fracture, most of which are distal radius fractures. We present an unusual case of a 2-year-old girl with an ipsilateral supracondylar humerus fracture and a Monteggia lesion. Our management consisted of percutaneous K-wire fixation of the supracondylar humerus fracture and percutaneous insertion of an intramedullary K-wire for stabilization of the ulna fracture. Our patient had an excellent result, and we would recommend this method of fixation for similar injuries.
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Affiliation(s)
- Robert S Powell
- Division of Orthopaedic Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Brunswick, New Jersey, USA
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22
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Abstract
We present two cases of ipsilateral Monteggia fracture-dislocations and intercondylar distal humerus fractures in adults. To our knowledge, this combination of injuries has not been described in skeletally mature individuals. Both patients were treated with rigid internal fixation of the bony injuries as well as early rehabilitation protocols. Despite the severity of the injuries, both patients had satisfactory results. Adherence to established internal fixation protocols is critical in the treatment of complex upper extremity injuries.
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Affiliation(s)
- Pedro K Beredjiklian
- Divisions of Hand Surgery, Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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23
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Hackl W, Gabl M, Gadner K, Zimmermann R, Sailer R. [Delayed radial paralysis after Monteggia fracture--a case report]. Unfallchirurg 2002; 105:569-71. [PMID: 12132198 DOI: 10.1007/s00113-002-0414-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Concomittant lesions of neural structures represent a rare type of complications in Monteggia's fractures. In acute fractures spontaneous neurological remission usually occurs after reduction of the dislocated radial head. In the presented case a 33-year old man experienced a trady palsy of the posterior interosseus nerve 27 years after a Monteggia's fracture with the radial head left dislocated. Following a minimal trauma in badminton a neurological deficiency probably caused by distraction occurred and resulted in impairment of wrist extension and extension of the fingers. Initiated conservative treatment including intensive physiotherapy and electrotherapy for 4 months was unsuccessful. Consecutively the radial nerve was surgically exposed and released from an entrapping and thickened arcade of Frohse. The radial head was left dislocated. Full neurological recovery was obtained 9 months after surgery.
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Affiliation(s)
- W Hackl
- Universitätsklinik für Unfallchirurgie Innsbruck, Anichstrasse 35, 6020 Innsbruck, Osterreich.
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24
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Abstract
Monteggia fractures represent approximately 1 to 2 percent of forearm fractures, whereas Galeazzi fractures represent 3 to 6 percent. The combination of these injuries in the same extremity is an exceedingly rare occurrence. We report a case of ipsilateral combination Monteggia and Galeazzi fractures in an adult patient. The patient was treated with anatomic reduction and rigid internal fixation. The radius was stabilized with a 3.5-millimeter dynamic compression plate (Synthes USA, Paoli, PA, U.S.A.) and the olecranon with tension band fixation. The radiocapitellar and distal radioulnar joint relationships were restored; the fractures healed; and the patient proceeded to obtain a satisfactory functional result at one year.
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Affiliation(s)
- David J Clare
- Nebraska Orthopaedic and Sports Medicine, Lincoln, Nebraska 68506, USA
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25
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Chick G, Court C, Nordin JY. [Complex fractures of the proximal end of the radius and ulna in adults: a new classification]. Rev Chir Orthop Reparatrice Appar Mot 2001; 87:765-72. [PMID: 11845080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Unlike injuries involving only one of the forearm bones, complex lesions of the proximal end of the radius and the ulna are particularly unstable. Various situations-Monteggia fracture, transolecraneal dislocation, or fracture-dislocation-are encountered. The classification systems proposed to date and recalled here are insufficient, making it difficult to provide optimal therapy and also hindering comparison between published series. We propose a descriptive classification including all the anatomic varieties of complex fractures of the proximal end of the radius and the ulna. This classification is based on our experience with 38 cases and takes into account 4 basic elements: the height of the ulnar fracture line, the direction of the displacement of the proximal radius, the association of a fracture of the proximal radius and/or of the coronoid process.
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Affiliation(s)
- G Chick
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre Cedex, France
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26
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Abstract
SUMMARY Ipsilateral elbow and wrist injuries are rare in children. We present a previously undescribed case of a Bado Type I Monteggia fracture with a Salter-Harris Type II epiphyseal injury of the distal radius. A satisfactory result was achieved but required surgical intervention. Complete diagnostic evaluation is imperative to avoid missed injuries and achieve satisfactory outcome.
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Affiliation(s)
- S Deshpande
- Royal Glamorgan Hospital, Llantrisant, Wales, United Kingdom
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27
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Osada D, Tamai K, Kuramochi T, Saotome K. Three epiphyseal fractures (distal radius and ulna and proximal radius) and a diaphyseal ulnar fracture in a seven-year-old child's forearm. J Orthop Trauma 2001; 15:375-7. [PMID: 11433147 DOI: 10.1097/00005131-200106000-00015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
SUMMARY The authors report a rare case of fracture separations at both ends of the radius combined with an epiphyseal and diaphyseal fracture of the ipsilateral ulna. A seven-year-old girl fell one story and sustained a closed injury of her forearm. A closed reduction was unsuccessful, and an open reduction was performed with three of the four fractures being secured with Kirschner wires. These wires were removed one month later, and range-of-motion exercises were started. Thirty months after surgery, both forearms were equal in length, although the proximal radial epiphyseal line appeared partially closed. Joint motions, including forearm rotation, were normal. Radiologically, the ulnar diaphysis and the radial neck were posteriorly convex 20 degrees and 18 degrees, respectively.
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Affiliation(s)
- D Osada
- Department of Orthopaedic Surgery, Dokkyo University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi 321-0293, Japan
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28
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Arenas AJ, Artázcoz FJ, Tejero A, Arias C. Anterior interosseous nerve injury associated with a Monteggia fracture-dislocation. Acta Orthop Belg 2001; 67:77-80. [PMID: 11284277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
A case of an anterior interosseous nerve palsy associated with a Monteggia fracture-dislocation is presented. The fracture of the ulna was reduced and stabilized with a plate, and the proximal radioulnar dislocation was also reduced. The nerve recovery was spontaneous and complete. A satisfactory result was obtained, without pain or functional sequelae.
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Affiliation(s)
- A J Arenas
- Department of Orthopedic Surgery, Hospital de Navarra, Irunlarrea, 3, Pamplona-31008, Navarra, Spain
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29
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Biyani A, Olscamp AJ, Ebraheim NA. Complications in the management of complex Monteggia-equivalent fractures in adults. Am J Orthop (Belle Mead NJ) 2000; 29:115-8. [PMID: 10695863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
We report five adult patients with complex Monteggia-equivalent fractures who were surgically treated, all of whom had significant complications. All ulnar fractures and three radial fractures developed nonunion. Three patients required more than two procedures to achieve bony union, and one required a total elbow arthroplasty.
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Affiliation(s)
- A Biyani
- Department of Orthopaedic Surgery, Medical College of Ohio, Toledo, USA
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30
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Abstract
The elbow in a pediatric patient does not usually have the propensity for stiffness like that of the elbow in an adult. There are some posttraumatic conditions of the elbow in the pediatric patient that do require reconstruction. These include reconstruction for malunion after supracondylar humerus fractures and after Monteggia fractures. Nonunion of lateral condyle fractures also may require reconstruction. The posttraumatic elbow contracture in the pediatric patient is an operative challenge when the patient does not respond to conservative treatment. Patients with osteochondritis dissecans resulting in osteochondral loose bodies, significant loss of motion, or radiocapitellar subluxation will benefit from surgery. An entrapped median nerve or medial epicondyle after an elbow fracture or dislocation is an impending disaster that requires reconstruction immediately on recognition.
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Affiliation(s)
- R Papandrea
- Department of Orthopaedic Surgery, Harvard Medical School, Children's Hospital, Boston, MA 02115, USA
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31
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Abstract
Nerve dysfunction after trauma around the elbow can lead to significant long-term pain and functional deficit. Fortunately, most of these injuries are neurapraxias that will recover spontaneously after conservative treatment. The necessity and time frame for surgical intervention for specific patterns of nerve dysfunction remains controversial. Often surgical exploration exacerbates rather than alleviates the presenting nerve problem. Distal humeral shaft fractures, elbow dislocations, Monteggia fracture-dislocations, supracondylar fractures in children, and proximal forearm trauma all have been associated with various types of nerve injuries with a variable degree of recovery. The early recognition of nerve dysfunction combined with appropriate treatment measures is the key to successful outcome.
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Affiliation(s)
- S Ristic
- New York-Presbyterian Orthopaedic Hospital, NY 10032, USA
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32
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Abstract
Ipsilateral elbow and forearm fractures are quite rare in children. We present a Monteggia lesion with ipsilateral supracondylar humerus fracture in a 13-year-old girl. Through early surgical management, a successful result was achieved. We believe that, to minimize any initial or subsequent complications in such fractures, early surgical management should be the first treatment choice.
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Affiliation(s)
- M Arazi
- Department of Orthopaedic Surgery and Traumatology, Selçuk University Medical School, Konya, Turkey
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33
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Jacobsen K, Holm O. [Chronic Monteggia injury in a child]. Ugeskr Laeger 1998; 160:4222-4223. [PMID: 9691823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The case of a Monteggia fracture neglected from two years of age and seen at the age of fourteen, is described. A shortening of the affected ulna by three cm and a relative elongation of the radius was found. The function of the arm and elbow joint was remarkably unaffected with nearly full extension and flexion, supination and pronation. The carrying angle was ten degrees on both sides. Based on the literature, it is stressed that diagnosis and treatment of Monteggia lesions should be immediate. Complications in non-treated cases and at late treatment are many, and the results of such treatment dubious. It is thus of great importance that, when dealing with ulnar fracture a radiograph is also taken of the elbow joint to secure immediate diagnosis.
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Affiliation(s)
- K Jacobsen
- H:S Frederiksberg Hospital, ortopaedkirurgisk afdeling og røntgenafdelingen
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34
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Abstract
The clinical features and results of treatment were reviewed in 17 traumatic palsies of the posterior interosseous nerve. Variations in clinical features depended on whether the recurrent branch or descending branch of the posterior interosseous nerve was injured. Seven patients had nerve repair, and two were treated by tendon transfers. Eight patients were treated conservatively. Sixteen of 17 patients recovered to more than M4 motor power at final follow-up. Associated muscle damage worsened the functional result.
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Affiliation(s)
- K Hirachi
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan
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35
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De Boeck H. Radial neck osteolysis after annular ligament reconstruction. A case report. Clin Orthop Relat Res 1997:94-8. [PMID: 9308530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The treatment of the dislocated radial head in a late Monteggia lesion remains a matter of controversy. Annular ligament reconstruction using a strip of triceps tendon is a commonly used technique. Although most published series report good and excellent results, the overall complication rate of this procedure is not known. This study reports a 9-year-old boy who had avascular necrosis and bone resorption of the radial neck after a late annular ligament reconstruction using a sling of triceps tendon for a radial head dislocation that was not detected previously.
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Affiliation(s)
- H De Boeck
- Department of Pediatric Orthopedic Surgery, AZK-VUB, Brussels, Belgium
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36
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Abstract
Forty-one patients who suffered from a Monteggia fracture and were treated between 1984 and 1993 were reviewed retrospectively using a new motion score of the elbow joint. There were 14 children and 27 adults of whom 34 were available for review. The results in children were significantly better than those of the adults. Among the adults, the final results of the patients who had a Bado Type 1 equivalent injury were significantly worse than those of the other groups, especially when associated with a fracture of the radial head. The type of fracture, open or closed, the presence of a fracture of the olecranon, and the energy level of the trauma did not have any significant prognostic value. Good correlation was shown between the new motion score and the Figgie elbow score. The Bado Type 1 equivalent injuries should be considered as a special subgroup of the Monteggia lesion, necessitating extra attention in treatment and rehabilitation, and a close followup of the patient.
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Affiliation(s)
- U Givon
- Department of Orthopaedic Surgery, Sheba Medical Center, Tel Hashomer, Israel
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37
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Chang MC, Liu Y, Lo WH. Wraparound injury of posterior interosseous nerve on the unreduced radial head: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1996; 58:459-63. [PMID: 9068216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Injury in radial nerve, especially its deep branch, posterior interosseous nerve (PION), is the most common nerve complication associated with Monteggia fracture. According to the reports by Boyd and Spinner, 100% of these injuries recovered spontaneously. Permanent or chronic radial nerve palsy caused by an unreduced radial head is very rare; the optimal treatment is still uncertain. Here a case of chronic PION injury in Monteggia fracture with unreduced radial head is reported.
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Affiliation(s)
- M C Chang
- Department of Orthopedics, Veterans General Hospital-Taipei, Taiwan, R.O.C
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38
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Abstract
We retrospectively reviewed the results of operative treatment of chronic Monteggia lesions (Bado type I or the equivalent) with anterior radiocapitellar dislocation in seven patients. The mean age at the time of the reconstruction was six years and nine months (range, eleven months to twelve years), and the mean time from the injury to the operation was twelve months (range, five weeks to thirty-nine months). The mean duration of follow-up was four years and six months (range, two years to eleven years and three months). There were fourteen complications, including malunion of the ulnar shaft in one patient; residual radiocapitellar subluxation in two patients (one anterior and one posterolateral); radiocapitellar dislocation (dynamic anterior subluxation of the radial head in supination) in one patient; transient ulnar-nerve palsy in three patients (with residual weakness in two); partial laceration of the radial nerve in one patient; loss of the fixation in two patients; and non-union of the ulnar osteotomy site, compartment syndrome, conversion reaction, and possible fibrous synostosis of the forearm in one patient each. The patients lost a mean of 36 degrees of pronation and a mean of 27 degrees of supination of the forearm compared with the contralateral, uninjured extremity. Two patients demonstrated a loss of flexion of the elbow of 8 and 13 degrees and three had a loss of extension (mean, 15 degrees) compared with the contralateral side. There were three good, two fair, and two poor results.
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Affiliation(s)
- W B Rodgers
- Department of Orthopaedic Surgery, Harvard Medical School, Boston Children's Hospital, Massachusetts 02115, USA
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39
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Abstract
A rare, previously undescribed combination of ipsilateral type III Monteggia equivalent and distal radial and ulnar fracture in a child is reported. A good result was obtained by nonoperative treatment.
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Affiliation(s)
- A Biyani
- Department of Orthopaedic Surgery, Arrowe Park Hospital, Upton, Wirral, England
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40
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Shonnard PY, DeCoster TA. Combined Monteggia and Galeazzi fractures in a child's forearm. A case report. Orthop Rev 1994; 23:755-9. [PMID: 7800404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report the occurrence of a previously undescribed combined Monteggia and Galeazzi fracture pattern of the left forearm in an 8-year-old boy. Previous reports do not address the combined injury described in this article, which consists of a left radius shaft fracture with dislocation of the distal radioulnar joint, and a left ulna shaft fracture with anterior dislocation of the radiohumeral joint. An excellent result was obtained with closed reduction. Radiographic evaluation is crucial in these disorders for both diagnosis and for treatment decisions. A review of the literature is provided with specific emphasis toward the classifications, mechanisms of injury, diagnosis, associated injuries, and treatment.
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Affiliation(s)
- P Y Shonnard
- University of New Mexico School of Medicine, Department of Orthopaedics and Rehabilitation, Albuquerque
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41
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Affiliation(s)
- J A Watson
- Department of Orthopaedic Surgery, Northwick Park Hospital, Harrow, UK
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42
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Abstract
Seven children with chronic post-traumatic dislocation of the radial head were treated by open reduction and ligament reconstruction by a triceps tendon slip. In the four patients with anterior dislocation, good results were achieved; in the two with anterolateral dislocations bowing of the ulna persisted and subluxation recurred. One patient with an anterior dislocation developed a radio-ulnar synostosis. For anterolateral dislocations, we advise the combining of open reduction and ligament reconstruction with osteotomy of the ulna.
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Affiliation(s)
- F C Oner
- Sophia Children's Hospital, Rotterdam, The Netherlands
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43
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Abstract
Two cases of posttraumatic radioulnar synostosis treated with excision and low-dose radiation are presented. Routine postoperative hand therapy was employed. Nearly full range of motion was restored in both cases. No wound healing problems were encountered. We suggest that low-dose radiation may be a useful method of prophylaxis against recurrence after excision of radioulnar synostosis.
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Affiliation(s)
- R A Abrams
- Department of Orthopaedics, University of California, San Diego 92103
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44
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Huang YC, Wu CC, Shih CH, Tsan YY. Monteggia fractures in adults. Changgeng Yi Xue Za Zhi 1993; 16:81-7. [PMID: 8339158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
From January 1978 to December 1989, 60 adult acute Monteggia fractures were treated and followed-up for at least one year (average 3 years 9 months). Ulnar fractures were treated with open reduction and internal fixation with a dynamic compression plate or a Rush pin, and 2 with minimal ulnar displacement were treated with closed reduction. Forty radial heads had a closed reduction, 6 required an open reduction with annular ligament repair or fascial reconstruction, and 14 were resected due to comminution. The results showed a 90% union rate with a 3.5 +/- 1.2 months union period. Functional evaluation revealed a 78% satisfactory rate. The unsatisfactory results were associated with severe soft tissue injury which restricted elbow range of motion, persistent posttraumatic neurological deficit of brachial plexus injury and subluxation or redislocation of the radial head. From theoretical and clinical considerations, the authors concluded that open reduction with rigid internal fixation of ulnar fracture and stable reduction of radial head should be the treatment of choice for Monteggia fractures.
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Affiliation(s)
- Y C Huang
- Dept. of Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, R. O. C
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45
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Affiliation(s)
- W B Rodgers
- Department of Orthopaedic Surgery, Children's Hospital, Boston, Massachusetts
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46
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Hertel P, Bernard M, Moazami-Goudarzi Y. [The malunited juvenile fracture--Monteggia defect]. Orthopade 1991; 20:341-5. [PMID: 1758698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Late reconstruction after neglected Monteggia lesions in children is discussed. On the basis of the literature (20 cases) and 2 personal cases it is deduced that open reduction of the radial head should be combined with osteotomy of the ulna according to the pathophysiology of the lesion. Details of the operative procedure are given. Reconstruction of the annular ligament is the least important part. Reconstruction is indicated in children under the age of 10-12 years even if the dislocation has been present for years. Unfavorable conditions for operative reconstruction are long-lasting dislocations in older children, deformation of the radial head, and imminent skeletal maturity.
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Affiliation(s)
- P Hertel
- Unfallchirurgische Abteilung, Martin-Luther-Krankenhauses, Berlin
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47
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Dormans JP, Rang M. The problem of Monteggia fracture-dislocations in children. Orthop Clin North Am 1990; 21:251-6. [PMID: 2326051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
When a Monteggia fracture is recognized and treated immediately, the results are excellent. Poor results are mostly caused by initially missing the diagnosis. Operative intervention is usually required for those fractures that are unstable after manipulation or recognized too late after injury.
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Affiliation(s)
- J P Dormans
- Fort Wayne Orthopedic Surgery Residency Training Program, Lutheran Hospital, Indiana
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48
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Abstract
A rare combination of an ulnar fracture with posterior dislocation of the head of the radius and intraarticular fracture of the distal radius concomitant with an ipsilateral navicular fracture is presented. To the best of our knowledge, no such case has been reported. The mechanism of this fracture combination is discussed with respect to its role in producing the Monteggia type II fracture. Treatment consisted of a combination of closed and open reduction with external fixation.
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Affiliation(s)
- M Nyska
- Department of Orthopaedic Surgery, Hadassah University Hospital, Jerusalem, Israel
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49
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Rubin SA, Wysong CB, Wilber MC. Unsuspected "isolated" dislocation of the radial head in an adult. South Med J 1986; 79:487-9. [PMID: 3704708 DOI: 10.1097/00007611-198604000-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We have described a patient who as a child sustained a Monteggia's fracture that was neither diagnosed nor treated. Neurologic deficit and limitation of motion were clinically apparent. A high index of suspicion, careful examination of the patient, and high-quality roentgenograms should enable accurate diagnosis of this and similar lesions in less obvious cases, thus avoiding the complications of missed diagnosis.
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50
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Abstract
A very rare case of type II Monteggia lesion with an associated fracture-separation of the distal radial epiphysis is reported and the mechanism of injury is discussed.
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