Tardy ulnar nerve palsy caused by chronic radial head dislocation after Monteggia fracture: a report of two cases

Nishimura, Masahiro; Itsubo, Toshiro; Horii, Emiko; Hayashi, Masanori; Uchiyama, Shigeharu; Kato, Hiroyuki

doi:10.1097/bpb.0000000000000302

Cited by 11 publications

(13 citation statements)

References 8 publications

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“…Other causes of tardy ulnar nerve palsy after childhood elbow trauma include cubitus varus 28e30 and Monteggia fracture dislocation. 31,32 Treatment of tardy ulnar nerve palsy secondary to cubitus valgus remains controversial and recommendations include anterior transposition with or without osteotomy. 33e36 There is no unanimity on the treatment of established nonunion of LHC.…”

Section: Cubitus Valgusmentioning

confidence: 99%

Not Kidding! Sequalae of elbow trauma in children

Lahoti¹,

Akilapa²

2021

Journal of Clinical Orthopaedics and Trauma

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Elbow injuries are common in children and while majority heal very well, some result in deformities of the elbow. Although deformities such as cubitus varus and non-progressive cubitus valgus are considered cosmetic by the paediatric orthopaedic surgeons and intentionally ignored, they are not always benign and can result in functional deficit due to instability, pain, tardy nerve palsies and osteoarthritis later in life. Similarly congenital and developmental conditions that do not cause major functional loss in childhood, become very disabling in adults due to increasing functional demands. Congenital radial head dislocation and radioulnar synostosis fall into this category. In this paper we discuss clinical presentation, treatment options and outcomes of common elbow conditions presenting later in the life.

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Section: Cubitus Valgusmentioning

confidence: 99%

Not Kidding! Sequalae of elbow trauma in children

Lahoti¹,

Akilapa²

2021

Journal of Clinical Orthopaedics and Trauma

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“…The resultant traction leads to the thickening of the nerve. Chronic dislocation of the radial head leads to repeated friction of the nerve against the bony surfaces, 18 which, in turn, causes chronic damage, and the nerve appears enlarged and hypoechoic as a result of fibrotic changes and exhibits a thickened external epineurium. However, in our study, the CSA of the PIN at L_dist did not increase.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic evaluation of radial nerve injuries associated with pediatric chronic monteggia lesions

Liu

Sui

et al. 2018

Muscle and Nerve

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Introduction: To determine the ultrasonographic evaluation of the radial nerve (RN) before correction of chronic pediatric Monteggia lesions in patients with suspected nerve injury. Methods: Twelve consecutive children with Monteggia lesions were investigated. The cross-sectional area (CSA) of the nerve and the nerve-to-skin (N-S) distance were determined by ultrasonography at 3 levels: 5 cm proximal to the humeroradial joint (L_prox), a horizontal line through the humeroradial joint (L_mid), and 2.5 cm distal to the humeroradial joint (L_dist). Results: The CSA was greater on the injured side than on the unaffected side at L_prox and at L_mid (P < 0.01), but no difference was noted for posterior interosseous nerve (PIN) at L_dist (P = 0.445). The N-S values were greater on the unaffected side than on the injured side (P < 0.01), but there was no difference at L_dist in superficial RN and PIN. Discussion: Ultrasonography allowed the preoperative assessment of the severity of RN injuries in chronic pediatric Monteggia lesions.Muscle Nerve 59: [326][327][328][329][330] 2019 Abbreviations: CSA, cross-sectional area; D dist1 , the depth from the SRN to the skin at point L_dist; D dist2 , the depth from the PIN to the skin at L_dist; D mid1 , the depth from the SRN to the skin at L_mid; D mid2 , the depth from the PIN to the skin at L_mid; D prox , the depth from the RN to the skin at L_prox; L_dist, 2.5 cm distal to the humeroradial joint; L_mid, horizontal line through the humeroradial joint; L_prox, 5 cm proximal to the humeroradial joint; N-S, nerve-to-skin; PIN, posterior interosseous nerve; RN, radial nerve; SRN, superficial radial nerve;; US, ultrasound

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“…[2,3] Numerous studies have been reported on the potential complications of Monteggia fracture, such as recurrent dislocation of the radial head, heterotopic ossification of the elbow, nerve palsy, malunion of the ulna, and residual forearm deformity. [4,5] However, to our knowledge, none of the reported cases in the orthopaedic literature refer to the injury sustained in our patient. Herein, we report a misdiagnosed case in which the patient underwent successively osteofascial compartment syndrome open decompression, ulnar open reduction and internal fixation (ORIF), as well as reoperation of old Monteggia fracture combined with secondary distal radioulnar joint (DRUJ) disruption.…”

Section: Introductionmentioning

confidence: 86%

A very rare presentation of reoperation combined both old Monteggia fracture and secondary distal radioulnar joint dislocation in adult

Zhang

Xiao²,

Li³

2019

Medicine

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Rationale: The old Monteggia fracture is an uncommon lesion pattern in adult, which may lead to the potential complications such as recurrent dislocation of the radial head, heterotopic ossification of the elbow, nerve palsy, malunion of the ulna, and residual forearm deformity. However, the secondary distal radioulnar joint (DRUJ) dislocation is rarely reported in the similar lesion. Here we present a unique reoperation of old Monteggia fracture combined with secondary DRUJ disruption after the initial operation failure. Patient concerns: A 38-year-old male presented to our hospital outpatient office complaining of left elbow stiffness and ongoing wrist dysfunction with a history of injury to the left forearm caused by a forklift accident that occurred 5 months previously. Diagnosis and interventions: At the local hospital, the patient underwent successively fasciotomy and decompression, ulnar open reduction, and internal fixation due to osteofascial compartment syndrome and a misdiagnosed ulnar fracture. Upon examination, the secondary dorsal dislocation of the DRUJ was obvious both clinically and radiographically. We performed a revision surgery called ulnar osteotomy, radioulnar ligament repair, and temporary fixation of the DRUJ with a Kirschner wire. Outcomes: The patient received a satisfactory result without observed redislocation and relapse according to the 1-year follow-up. Lessons: Considering the notoriously poor outcomes, the importance of early recognition and accurate treatment should be emphasized repeatedly in similar lesions. Paying close and continuous attention to the clinical and radiographic examinations of the elbow and wrist joint is necessary to avoid misdiagnosis and missed diagnosis.

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Tardy ulnar nerve palsy caused by chronic radial head dislocation after Monteggia fracture: a report of two cases

Cited by 11 publications

References 8 publications

Not Kidding! Sequalae of elbow trauma in children

Not Kidding! Sequalae of elbow trauma in children

Ultrasonographic evaluation of radial nerve injuries associated with pediatric chronic monteggia lesions

A very rare presentation of reoperation combined both old Monteggia fracture and secondary distal radioulnar joint dislocation in adult

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