Management of Missed Monteggia Fractures With Ulnar Osteotomy, Open Reduction, and Dual-socket External Fixation

Liu, Xuemin; Wang, Yu Kun; Zhang, Jianli; Zhu, Zhenhua; Guo, Yuan; Lu, Ming

doi:10.1097/bpo.0b013e3182812762

Cited by 39 publications

(58 citation statements)

References 13 publications

(6 reference statements)

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“…The majority of authors had used triceps fascia graft (n = 8) [10,16,17,19,20,24,28,31], followed by triceps tendon (n = 6) [9,11,12,22,25,32], annular ligament remnant (n = 5) [15,18,22,28,34], and forearm fascia (n = 4) [18,30,35,36]. The majority of authors had used triceps fascia graft (n = 8) [10,16,17,19,20,24,28,31], followed by triceps tendon (n = 6) [9,11,12,22,25,32], annular ligament remnant (n = 5) [15,18,22,28,34], and forearm fascia (n = 4) [18,30,35,36].…”

Section: Resultsmentioning

confidence: 99%

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Neglected Monteggia fracture dislocations in children

Goyal

Arora

Banerjee

et al. 2015

Journal of Pediatric Orthopaedics B

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Monteggia fractures are uncommon and frequently missed injuries in children. This article aims to study, in a systematic manner, the surgical management and complications of treatment of chronic radial head dislocations. After screening of relevant abstracts, a total of 28 studies were included in the systematic review. A narrative synthesis of various treatment modalities has been discussed. This article concludes that open reduction should be attempted unless dysmorphism of the radial head restricts it. Open reduction with ulnar osteotomy with or without annular ligament reconstruction is the most commonly performed procedure and is expected to result in reduced pain and elbow deformity.

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Section: Resultsmentioning

confidence: 99%

“…Osteotomy was carried out at the fracture site in four studies [18,27,35,36]. Transverse opening wedge osteotomy (Hirayama type) was the most common procedure [13][14][15]22,27,29,31], followed by the oblique osteotomy [28,34].…”

Section: Resultsmentioning

confidence: 99%

Neglected Monteggia fracture dislocations in children

Goyal

Arora

Banerjee

et al. 2015

Journal of Pediatric Orthopaedics B

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“…Several authors insist that ALR is crucial for stability of the radial head and are concerned about the lack of stability of the radial head without reconstruction of the annular ligament 15373839. However, others found that ALR was not mandatory 6891019. Moreover, other complications, including osteolytic changes, narrowing of the radial neck, growth disturbance, heterotopic ossification, and osteonecrosis of the radial head, have been reported after ALR 2935404142.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment is usually recommended for patients with pain or limited functionality with loss of elbow motion, in whom the concave morphology of the radial head is preserved 5. For this, there are various surgical treatment options, including open reduction of the radial head and ulnar osteotomy with or without annular ligament reconstruction (ALR),26789101112131415 closed reduction by ulnar correction using single-stage osteotomy,16171819 or gradual distraction lengthening using an external fixator 202122. Although many studies have reported various techniques, there is no established standard treatment protocol for missed Monteggia fracture.…”

Section: Introductionmentioning

confidence: 99%

“…Some surgeons have performed open reduction of the radial head as a first procedure before ulnar osteotomy or ALR to remove posttraumatic fibrosis and annular ligament remnants,7810152324 while others insist that indirect reduction of the radial head by ulnar osteotomy could achieve good results without open reduction 171819202122. Moreover, several papers have reported satisfactory results with open reduction alone in some patients with missed Monteggia fracture 1462526.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Open Reduction on Surgical Strategies for Missed Monteggia Fracture in Children

Park

et al. 2017

Yonsei Med J

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PurposeThe aims of this study were to review our cases of missed Monteggia fracture treated by open reduction of the radial head with or without ulnar osteotomy and to investigate the indications for open reduction alone in surgical treatment of missed Monteggia fracture.Materials and MethodsWe retrospectively reviewed 22 patients who presented with missed Monteggia fracture. The patients' mean age at the time of surgery was 7.6 years. The mean interval from injury to surgery was 16.1 months. The surgical procedure consisted of open reduction of the radiocapitellar joint followed by ulnar osteotomy without reconstruction of the annular ligament. The mean period of follow-up was 3.8 years. Radiographic assessment was performed for the maximum ulnar bow (MUB) and the location of the MUB. Clinical results were evaluated with the Mayo Elbow Performance Index and Kim's scores.ResultsFive patients underwent open reduction alone, and 17 patients underwent open reduction and ulnar osteotomy. When the MUB was less than 4 mm and the location of the MUB was in the distal 40% of the ulna, we could achieve reduction of the radial head without ulnar osteotomy. The radial head was maintained in a completely reduced position in 21 patients and was dislocated in one patient at final follow-up.ConclusionOpen reduction alone can be an attractive surgical option in select patients with missed Monteggia fracture with minimal bowing of the distal ulna. However, ulnar osteotomy should be considered in patients with a definite ulnar deformity.

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