J Korean Orthop Assoc.  2009 Aug;44(4):473-479.

Treatment of Neglected Monteggia Fracture-Dislocation in Children

• Shim JS
• Seo SW
• Ahn JH
• Kim SM

Abstract

PURPOSE
Our purpose is to evaluate the results of the operative treatment in neglected Monteggia fracture-dislocation in children. MATERIALS AND METHODS: We retrospectively analyzed 10 elbows in 10 patients who underwent surgery. All patients were classified as Bado type I, except one with type III. The mean duration of follow up was 2 years and 5 months. The mean age at the time of operation was 10 years and the mean time from injury to operation was 7 months. All 10 patients underwent open reduction of the radial head and reconstruction of annular ligament. Ulnar osteotomy was performed in 9 cases. Clinical assessment was done by Bruce et al.'s rating system. RESULTS: All 10 patients gained a mean of 35degrees of extension-flexion arc, however lost a mean of 29degrees of pronation-supination arc. And there were three complications, including dislocation of radial head in two patients and breakage of transarticular K-wire in one patient. According to Bruce et al.'s rating system, there were 4 excellent, 1 good, 3 fair, and 2 poor results. CONCLUSION: We found that the effect of the operative treatment of neglected Monteggia fracturedislocation in children was limited in majority of the patients. Particularly, the loss of pronation-supination arc was noticed postoperatively in most patients.

Keyword

Monteggia fracture-dislocation; Surgery; Functional result

MeSH Terms

Child
Dislocations
Elbow
Follow-Up Studies
Head
Humans
Ligaments
Osteotomy
Retrospective Studies

Figure

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  Fig. 1 (A) Radiographs from a 8-year-old boy obtained at 3 months after trauma show an anterior dislocation of the radial head and a plastic deformation of the ulna. He had been immobilized with long arm cast for 2 weeks immediately after the injury. (B) Open reduction, reconstruction of the annular ligament and ulnar osteotomy were performed 3 months after the injury. (C) AP and lateral radiographs following 2 years show the normal alignment of radiocapitellar line and negative ulnar bow sign with no pain, no deformity and good function. But the range of pronation was decreased from 80° to 20°.

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  Fig. 2 (A) Anterior and lateral radiographs of the forearm show an anterior dislocation of the radial head. (B) Open reduction of the radial head, ulnar osteotomy and annular ligament reconstruction were performed 3 months after the injury. (C) At 4 months after operation, he was fallen on elbow and then, redislocation of the radial head was detected. (D) Anterior dislocation of the radial head has persisted for 2 years after the surgery, but there has been no pain and no decrease of range of motion.

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