The treatment of chronic radial head dislocation in Monteggia fracture without annular ligament reconstruction

Chen, Hsuan Yu; Wu, Kuan‐Wen; Dong, Zheng-Ren; Huang, Su‐Cheng; Kuo, Ken N.; Wang, Ting‐Ming

doi:10.1007/s00264-018-3943-6

Cited by 28 publications

(48 citation statements)

References 18 publications

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“…Wilkins [[11]] suggested that surgery should be performed within 12 years of age. In recent years, a growing number of researchers believe that surgery is better when the patient is younger than 10 years old, and when the dislocation is less than 12 months old [[12], [13]] . In the current study, the dislocation time of our selected cases were all within one year to eliminate the interference of dislocation time and age on the study.…”

Section: Discussionmentioning

confidence: 99%

Influence of Ulnar Bow Sign on Surgical Treatment of Missed Bado Type I Monteggia Fracture in Children

Liao

Wang

Huang

et al. 2020

Preprint

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PurposeThe present study aimed to explore the influence of ulnar bow on the surgical treatment of Bado type I missed Monteggia fracture in children.MethodsThis study is a retrospective review of 24 patients between November 2010 and March 2019. All patients were treated with open reduction of the radial head and ulnar opening wedge osteotomy without annular ligament reconstruction. The mean interval between injury onset and surgery was five months (range: 2–12 months). The average age of participants at the time of surgery was 6.4 years (range: 3–10 years). We evaluated the maximum ulnar bow (MUB) and MUB position (P-MUB) via radiography. The patients were divided into middle group (group A: 14 cases, MUB located at 40% to 60% of the distal ulna) and distal group (group B: 10 cases, MUB located at 20% to 40% from the distal end of the ulna) based on P-MUB. The mean period of follow-up was 37 months (range: 6–102 months).ResultsAt the last follow-up, all the children showed stable reduction of the radial head, and the flexion function of elbow joint improved after operation (P<0.05). Group A presented a larger the ratio of maximum ulnar bow(R-MUB) and angle of ulnar osteotomy(OA) than group B (P<0.05). There was statistically significant difference between group A and Group B in the P-MUB (P < 0.05). The osteotomy angle was positively correlated with the R-MUB (R2 =0.497,P=0.013), The osteotomy angle was positively correlated with the P-MUB (R2=0.731,P=0.000), The R-MUB is proportional to the P-MUB (R2 =0.597,P=0.002). The regression equation of P-MUB and osteotomy angle: Angle=7.064+33.227* P-MUB (R2=0.459, P =0.000).ConclusionWhen the ulnar bow is positioned at the middle ulna, a stable reduction of radial head need to be achieved through a larger angle in the ulnar osteotomy. If the position of maximum ulnar bow (P-MUB) is closer to the middle of the ulna or the ratio of maximum ulnar bow (R-MUB) is larger, the osteotomy angle is larger.

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Section: Discussionmentioning

confidence: 99%

Influence of Ulnar Bow Sign on Surgical Treatment of Missed Bado Type I Monteggia Fracture in Children

Liao

Wang

Huang

et al. 2020

Preprint

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“…Whether the annular ligament should be repaired is still controversial. Altaf A Kawoosa and Hsuan-Yu Chen (6,7) concluded that reducing the radial height effectively achieved reduction without open reduction, and annular ligament reconstruction could restore elbow function and improve elbow pain and stability. G. Canton et al (27) indicated that annular ligament rupture affected elbow joint biomechanics and resulted in radial head dislocation.…”

Section: Validation Of the Finite Element Modelmentioning

confidence: 99%

Finite Element Analysis of Elbow Joint Stability by Different Flexion Angles of the Annular Ligament

Xu¹,

Zhou²,

Yang³

et al. 2020

Preprint

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ObjectiveTo investigate the biomechanical effects of different flexion angles of the annular ligament on elbow joint stability. MethodsLeft elbow CT and MRI scans were chosen from a healthy volunteer, according to a previous research model. A cartilage and ligament model was constructed with SolidWorks software according to the MRI results to simulate the annular ligament during normal, loosen, and rupture conditions at different buckling angles (0, 30, 60, 90, 120). In 15 elbow models, boundary conditions were set according to the literature. The different elbow 3D finite element models were imported into ABAQUS software to calculate and analyze the load, contact area, contact stress and stress of the medial collateral ligament of the olecranon cartilage. Results1. According to the analysis results, olecranon cartilage stress values when the annular ligament under different conditions（normal、loosened、ruptured）with elbow extension, were 2.1 ± 0.18, 2.4 ± 0.75, and 2.9 ± 0.94 MPa. As the buckling angle increased, the stress value decreased; with 120 degrees of elbow flexion, the minimum stress values were 0.9 ± 0.12, 1.1 ± 0.38, and 1.2 ± 0.29 MPa. 2. When the contact surface of the olecranon cartilage was flexed from 0 to 30 degrees, the olecranon cartilage contact area significantly increased, reaching a maximum value of 254±5.35 mm, and then the contact area gradually decreased, reaching a minimum value of 176±2.62 mm when the elbow joint was flexed to 120 degrees. The results when the annular ligament was loosened and ruptured were different from those of the normal annular ligament. The maximum values were 283±4.74and 312±5.49mm at 60 degrees of elbow flexion. The contact area gradually decreased with an increase in the angle, and the minimum values were 210±3.82 and 236±6.59 mm at 120 degrees of elbow flexion. 3. When the elbow joint was extended, the maximum stress of the medial collateral ligament was 6.5±0.23, 11.5±0.78 and 18.7±0.94 MPa under different states; as the stress decreased with an increase in the angle, the corresponding values were 2.8±0.18, 4.8±0.56 and 6.2±0.72 MPa at 120 degrees of elbow flexion. ConclusionThe annular ligament plays an important role in maintaining elbow joint stability. When the annular ligament ruptures, it should be reconstructed as much as possible to avoid the elevation of stress on the surface of the medial collateral ligament of the elbow and on the annular cartilage, which may cause clinical symptoms.

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“…Plenty of researchers have reported managements of NMF with different outcomes in recent years (9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49). This review aims at summarizing and discussing the current knowledge of NMF, including its definition, its pathophysiological characteristics, the biomechanics of which the radial head slips, and surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

Neglected Monteggia fracture: a review

Zhang

Wang

et al. 2022

EFORT Open Reviews

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Monteggia fracture is characterized by radial head dislocation combined with proximal ulnar fracture. If not diagnosed at an early stage, these lesions can gradually lead to forearm deformities and dysfunction, finally resulting in neglected Monteggia fracture. When the radial head is not reduced, several deformities develop at the humeroradial joint, including cubitus valgus and osteoarthritis. Adequate radiographs are crucial when the surgeons deal with forearm injuries. At present, proximal ulnar osteotomy and open reduction of chronic radial head dislocation provides satisfactory functional outcomes because of anatomic alignment reconstruction. Supplementary procedures, including transcapitellar pinning and repair or reconstruction of the annular ligament, which are performed in order to enhance stability of the humeroradial joint, should be thoroughly assessed based on joint rotational stability after reduction and on potential complications.

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The treatment of chronic radial head dislocation in Monteggia fracture without annular ligament reconstruction

Abstract: IV.

Cited by 28 publications

References 18 publications

Influence of Ulnar Bow Sign on Surgical Treatment of Missed Bado Type I Monteggia Fracture in Children

Influence of Ulnar Bow Sign on Surgical Treatment of Missed Bado Type I Monteggia Fracture in Children

Finite Element Analysis of Elbow Joint Stability by Different Flexion Angles of the Annular Ligament

Neglected Monteggia fracture: a review

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