Purpose of review The chronic Monteggia may lead to pain, mobility limitation, progressive valgus deformity, lateral elbow instability, late ulnar nerve paralysis, and degenerative changes. In this review, we discuss the current procedures in the literature focused on correcting chronic Monteggia to avoid these complications. Recent findings Correction of the ulnar deformity with elongation and angulation of the ulna in the opposite direction of the dislocation of the radial head is the most important factor for the reduction and consequent preservation of the radial head. This correction reestablishes the relation of the ulna with the radius and increases the space of the interosseous membrane, providing greater stability after the reduction. The correction may be performed in the acute phase and stabilized with a properly molded plate and screws, or done progressively with an external fixator. Summary The chronic Monteggia may occur along with undiagnosed lesions, such as plastic deformation of the ulna with radial head dislocation, or after an unsuccessfully treated acute Monteggia lesion. This condition may go unnoticed, thus requiring attention to the physical examination and imaging tests. Chronic Monteggia may be treated by ulnar osteotomy with progressive correction with an external fixator. However, the most common treatment is transverse proximal ulnar osteotomy, capsulotomy and removal interposed tissue, reduction of the radial head to the capitellum and temporary transcapitellar fixation, ulnar fixation with a straight plate molded to the ulnar deformity, which is usually deviated dorsally, removal of the transcapitellar Kirschner-wire, stability test, and, if necessary, annular ligament reconstruction.
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), and one patient had a 15° decrease in supination. We did not observe any redislocation of the radial head in the follow-up evaluation. No complications were observed; the only complaint was salience of the ulnar plate.Conclusions:Our results demonstrated an effective option for the treatment of chronic Monteggia fracture-dislocation in children, even with a small study sample, following the presented technical and surgical strategies. Level of evidence IV, Therapeutic Studies.
Femoroacetabular impingement may occur in mild slips and certainly occur in cases of moderate and severe slips. The initial management depends on the severity and the stability of the slip.The modified Dunn procedure is a good option for the treatment of unstable SCFEs. Gentle closed reduction with capsulotomy (Parsch) may be considered whenever the surgeon is not comfortable with the modified Dunn procedure.Hips with open physis and stable moderate or severe SCFE, the modified Dunn procedure can be indicated. Cases with closed physis are managed with intertrochanteric osteotomy combined with osteoplasty.In the presence of symptomatic FAI secondary to SCFE, one should consider arthroscopic osteoplasty or surgical hip dislocation (with or without osteotomies) as treatment options.
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