Repositioning of the Annular Ligament in the Management of Missed Monteggia Fracture

Liu, Xuemin; Yan, Guisen; Wang, Yukun; Zhu, Zhenhua; You, Haifeng; Zhang, Jianli; Guo, Yuan

doi:10.1097/bpo.0000000000000584

Cited by 23 publications

(40 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These authors operated on select patients with missed Monteggia fracture using open reduction only, reporting good results. Among them, one report recommended that open reduction with repositioning or repair of the annular ligament might be a favorable option 26. In our study, we achieved stable reduction of the radial head with open reduction alone in five patients.…”

Section: Discussionsupporting

confidence: 52%

“…Open reduction alone is not sufficient to obtain and maintain reduction of the radial head in all patients with missed Monteggia fracture and has been used in only a few studies 1462526. These authors operated on select patients with missed Monteggia fracture using open reduction only, reporting good results.…”

Section: Discussionmentioning

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. Although these reports could not suggest the indications for open reduction alone for missed Monteggia fracture, open reduction alone might be the ideal procedure in select patients.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Park

et al. 2017

Yonsei Med J

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Park

et al. 2017

Yonsei Med J

View full text Add to dashboard Cite

show abstract

“…In study of Park et al, ulnar osteotomy and correction of the ulnar deformity are the key components to achieve reduction and this is also true in our study Another study showed both ulnar ostetomy and annular ligament reconstruction are required. 19 Another study shows good to excellent results in chronic Monteggia fractures if surgery performed before radial head is deformed. 20 Transcapitellar wire insertion is also debatable.…”

Section: Discussionmentioning

confidence: 98%

Ulnar osteotomy is the only required procedure for chronic monteggia fracture in children.

Adeel

Alam

Hussain

et al. 2021

TPMJ

View full text Add to dashboard Cite

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 and screws. Results: 10 patients were included in this study. The age range was between 4 and 10 years. The study period was six months and follow up was one year. Mean ulnar angulation at osteotomy site was 21.3° (16-25°). Mean ulnar lengthening at osteotomy site was 0.85 cm (0.5-1.8 cm).Improvement in flexion-extension was 20.3%, pronation was 5.1% and supination was 13.7%. Complications included were nounion in 1 case and cubitus valgus in 1 case. Conclusion: Containment of radial head is obtained by open reduction of radial head and with ulnar osteotomy in chronic Monteggia fractures. Annular ligament reconstruction and transcapitellar wire insertion are not required if proper angulation and fixation of ulnar osteotomy is performed. No age limit for this procedure but surgery should be performed before radial head deformation.

show abstract

“…We used the Henry approach, as described in previous studies. 4 Once the muscles adjacent to the radiocapitellar joint had been cleared, the pseudocapsule surrounding the capsule was opened from the distal to the proximal region to expose the radial head. Then, we evaluated the state of the cartilage of the radial head.…”

Section: Surgical Techniquementioning

confidence: 99%

Treatment of missed Monteggia fracture with intact annular ligament after an interval of 9 years: a case report and literature review

Zhou

2020

J Int Med Res

View full text Add to dashboard Cite

Objective Missed Monteggia fractures are commonly observed among children. Both the interval from the injury to surgery and the patient’s age at operation are thought to be correlated directly with the success of the surgery and prognosis. The aim of the present work was to report one interesting adult case of a missed Monteggia fracture with an intact annular ligament 9 years after injury and the outcomes at a 7-year follow-up. Case description One missed lesion with a 9-year delay for surgery occurred in a skeletally mature individual, and it was treated by open reduction and ulnar angulation and elongation osteotomy. The annular ligament was interpositioned intact in the radiocapitellar joint, and therefore, instead of the annular ligament reconstruction (ALR), relocation was performed. Results After one revision surgery for the complication of nonunion, good radiographic and functional outcomes were eventually sustained at the 7-year follow up. Conclusion Good radiographic and functional outcomes can be expected in adult patients in whom the annular ligament is intact and interpositioned, and this was treated by open reduction and ulnar osteotomy 9 years after the initial injury in our patient.

show abstract

Repositioning of the Annular Ligament in the Management of Missed Monteggia Fracture

Abstract: Level IV-therapeutic.

Cited by 23 publications

References 11 publications

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

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

Ulnar osteotomy is the only required procedure for chronic monteggia fracture in children.

Treatment of missed Monteggia fracture with intact annular ligament after an interval of 9 years: a case report and literature review

Contact Info

Product

Resources

About