Neglected Monteggia Fractures in Children—A Retrospective Study (original) (raw)
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Functional outcomes of pediatric true and equivalent Monteggia fractures – Review of the literature
Turkish Journal of Trauma and Emergency Surgery
BACKGROUND: This study aims to describe the functional outcome of true and equivalent Monteggia fracture-dislocations in the pediatric population. We also provided a review of the literature about the treatment options. METHODS: Five surgically and three conservatively treated patients were identified who were treated in 2009-2021. The study population consisted of six female and two male patients. The mean age at the time of treatment was 7. The mean follow-up time was 55 months (range, 12-128). The Mayo Elbow Performance Score and the Oxford Elbow Score were used for outcome evaluation. Range of motion and grip strengths were also evaluated. RESULTS: There were two Bado type 1 and six Monteggia equivalent injuries. Closed reduction and casting were utilized for the two Bado type 1 injuries as the initial treatment. However, one had a radial head re-dislocation and had to be treated operatively. This patient had a radial head re-dislocation after the surgery and was followed up conservatively. Three Monteggia equivalent injuries were treated with closed reduction and casting, with no complications. One patient had a radial head anterior dislocation with plastic deformation of the ulna, and this patient was managed with CORA-based corrective ulnar osteotomy. For Monteggia injuries, the main treatment objective is to restore the ulnar length. Bilateral computed tomography imaging with 3D reconstruction can be utilized in preoperative planning of Monteggia fracture-dislocations to customize the treatment. Close observation is essential to detect radial head subluxation, which needs early intervention before irreversible changes occur. CONCLUSION: The true/equivalent Monteggia fractures' main treatment goal is to restore the ulnar length. Conservative treatment, with a close follow-up, is the first option if closed reduction can be achieved. If closed reduction is not possible, careful preoperative planning and early rehabilitation are key to success for management of Monteggia fractures.
Surgical Outcome of Neglected Monteggia Fracture-Dislocation in Pediatric Patients: A Case Series
Shafa Orthopedic Journal, 2019
Background: Treatment of Monteggia fracture-dislocations can become quite complicated when the diagnosis is delayed. Objectives: We report the outcome of open reduction and ulnar osteotomy with annular ligament repair or reconstruction in pediatric patients with neglected Monteggia fracture-dislocation. Methods: In a retrospective study, pediatric patients with neglected Monteggia fracture-dislocation who underwent open reduction and ulnar osteotomy with annular ligament repair or reconstruction were included. The radiologic evaluations included the assessment of the union of the osteotomy site and elbow joint degenerative changes or peri-articular ossifications. The clinical evaluation of outcomes included the range of motion (ROM) and the Kim elbow performance score (KEPS). Results: A total number of seven patients with pediatric Monteggia fracture-dislocations and the mean age of 6.6 ± 2.7 years were evaluated. The mean delayed time from injury to surgery was 53.3 ± 31.4 days. The mean follow-up of the patients was 30.8 ± 25.5 months. The mean flexion arc, supination, and pronation were 137.9°, 72.1°, and 65.7°, respectively. Flexion contracture was present in two cases only. The mean KEPS of the patients was 96.4 ± 6.3. Accordingly, the outcome was excellent in six (85.7%) patients and good in one (14.3%). One ulnar nonunion and one heterotopic ossification were recorded as post-operative complications. No case of subluxation, dislocation, or degenerative joint disease was seen in our series. Conclusions: Radial head reduction and ulnar osteotomy with annular ligament reconstruction result in acceptable radiologic and clinical outcomes in the management of neglected pediatric Monteggia fracture-dislocation.
Chronic Monteggia Fracture-Dislocation in Children Surgical Strategy and Results
Acta Ortopédica Brasileira, 2019
Objective: To report surgical techniques and results in the treatment of chronic Monteggia fracture-dislocation in children. Methods: Six pediatric patients who had undergone a procedure involving the following 6 crucial surgical steps were retrospectively evaluated: 1- extended lateral approach, 2- fibrotic removal, 3-proximal ulnar osteotomy, 4- reduction of the radial head and transcapitellar temporary fixation, 5- ulnar fixation with a straight plate shaped according to the deformity generated by temporary fixation, and 6- transcapitellar Kirschner wire removal. Results: Four patients were women, and four showed the right-sided compromise. The mean age of patients was 8 years, and the minimum follow-up period was 12 months. The mean time from the onset of fracture to treatment was 6 months. Six patients underwent complete flexo/extension, and one patient had a complete prono-supination. In four patients, we observed loss of pronation (by 10° in two, 15° in one, and 20° in one), ...
Ulnar osteotomy is the only required procedure for chronic monteggia fracture in children
The Professional Medical Journal, 2021
Objective: To determine containment of radial head after ulnar osteotomy in chronic Monteggia fractures. Study Design: Retrospective study. Setting: Children Hospital and The Institute of Child Health, Lahore. Period: 2019 to January 2020. Material & Methods: Ten patients presented in outdoor patient department with a diagnosis of chronic Monteggia fracture. Four patients were labelled as missed Monteggia fractures, four with late presented Monteggia fractures and two with inadequately treated Monteggia fractures. Bado and Letts classifications were applied for patients. Mean age was 6 years and 8 months and ranged from 4 to 10 years. Mean time interval between injury and admission was 6.1 months. Open reduction of radial head and ulnar osteotomy was done through Boyed approach. Transcapitellar wire was inserted temporarily and then removed so it is not required permanently. The ulnar osteotomy was angulated opposite to the direction of radial head dislocation and fixed with plate a...
Monteggia fracture dislocation equivalent in children: A rare case report
2021
Monteggia fractures account for less than 1% of all paediatric elbow dislocations, with a peak age of 4 to 10 years. Although rare, they receive considerable interest because they are often missed, resulting in poor outcomes. There have been numerous reports of Monteggia equivalents including the three most common- isolated radial head dislocation, fracture of the proximal ulna with fracture of the radial neck and both bone proximal third fractures with radial fracture more proximal than the ulnar fracture. We present a case of 6 year old boy with minimally comminuted metaphyseal fracture of ulna extending to proximal diaphysis with anterior dislocation of radial head managed by closed reduction and fixation by percutaneous Kirschner-Wires.
Neglected monteggia fracture-dislocations in children
Journal of Clinical and Analytical Medicine
Aim: Presently, there are few large-scale studies and no clear consensus on the type of osteotomy or ligamentoplasty to be performed in neglected Monteggia fractures-dislocations cases. The goal of this study was to report the results from neglected Monteggia fractures and dislocations. Material and Method: Thirteen children and adolescents with neglected Monteggia fractures and dislocations were treated between 2009 and 2012. There were 11 males and two females with a mean age of 8.5 (range 2-15) years. Based on the BADO classification, 11 patients had type 1, one patient had type 3, and one patient had type 4 injuries. Time delay from symptom onset to fracture was 8.84 (3-24) months. The data were analyzed using R version 3.1.1 and multiple statistical analyses were conducted. Results: A postoperative Mayo Elbow Performance Index (MEPI) at the time of follow-up was recorded. Nine patients received an excellent grade, while three had good and one had a fair result with no poor results recorded. Radiographically, there were nine good, four fair, and no poor score results. The length of hospitalization was a mean of 3 days. The mean duration of follow-up was 2.9 (range 1.5-4.5) years from the initial presentation, and only one patient developed subluxation for which no additional intervention was performed. Discussion: This case series demonstrates that early diagnosis increases the success rate in patients younger than 10 years and less than a 1-year interval between the trauma and diagnosis. Unless it is kept for a prolonged time, a condyloradial pin can be applied in necessary cases. Level of evidence: IV
The Monteggia fracture : serie of 20 cases
Pan African Medical Journal, 2014
The Monteggia fracture is one of the pitfalls of conventional diagnosis of upper limb trauma. Through a retrospective study of 20 cases diagnosed
The Journal of Bone and Joint Surgery. British volume, 2007
The objective of this retrospective study was to correlate the Bado and Jupiter classifications with long-term results after operative treatment of Monteggia fractures in adults and to determine prognostic factors for functional outcome. Of 63 adult patients who sustained a Monteggia fracture in a ten-year period, 47 were available for follow-up after a mean time of 8.4 years (5 to 14). According to the Broberg and Morrey elbow scale, 22 patients (47%) had excellent, 12 (26%) good, nine (19%) fair and four (8%) poor results at the last follow-up. A total of 12 patients (26%) needed a second operation within 12 months of the initial operation. The mean Broberg and Morrey score was 87.2 (45 to 100) and the mean DASH score was 17.4 (0 to 70). There was a significant correlation between the two scores (p = 0.01). The following factors were found to be correlated with a poor clinical outcome: Bado type II fracture, Jupiter type IIa fracture, fracture of the radial head, coronoid fracture...