EC Orthopaedics

Research Article Volume 15 Issue 10 - 2024

Ulnar Osteotomy, Recontructe Annular Ligament by Fascia Lata for Neglected Monteggia Fracture Dislocation in Children

Nguyen Ngoc Hung*

Surgical Department, Vietnam National Hospital for Pediatric, Ha Noi Medical University, Vietnam

*Corresponding Author: Nguyen Ngoc Hung, Surgical Department, Vietnam National Hospital for Pediatric, Ha Noi Medical University, Vietnam.
Received: October 29, 2024; Published: November 14, 2024



Background: Neglected Monteggia fracture dislocations in children cause significant disability in terms of pain, stiffness, deformity, neurological deficits, and limitation of activities of daily living. Various surgical techniques have been described for the treatment of neglected Monteggia fracture dislocations.

Materials and Methods: In a prospective study, 35 patients with a mean age of 10 years 1 month, with neglected Monteggia fracture dislocations were studied. All children underwent open surgery to reduce the ulna, ulna osteotomy with angle reduction, and reconstruction of the annular ligament using the latissimus dorsi. The author used the Kim scale to evaluate results.

Results: There were 35 patients, the gender of the cases was 21 girls and 14 boys; the right side was affected 13 cases and the left side was affected 22 cases. The mean time from injury to presentation was 10.1 months. 17 patients were classified as Bado type I; 12 patients as Bado type II and 6 as Bado type III. The mean preoperative flexion-extension range of motion was (100.7°) and the mean postoperative range of motion was (131.25°), resulting in a mean increase of 43° (283°-240°) in the range of motion. All patients had a supination-pronation arc of >100°; the pronation range was always smaller than the pronation range. 28 patients had excellent and 6 patients had good results, and one patient had fair results at the last follow-up.

Conclusion: Surgical reduction is recommended unless radial head deformity is limited. Open reduction with ulnar osteotomy with annular ligamentotomy is the most commonly performed procedure and is expected to reduce elbow pain and deformity.

 Keywords: Missed Monteggia Fracture; Annular Ligament Reconstruction; Ulnar Reduction; Radial Reduction; Bone Graft

  1. Monteggia GB. Instituzioni Chirurgiche Milan, Maspero (1814).
  2. Devnani AS. “Missed Monteggia fracture dislocation in children”. Injury2 (1997): 131-133.
  3. Bhaskar A. “Missed Monteggia fracture in children: Is annular ligament reconstruction always required?” Indian Journal of Orthopaedics 4 (2009): 389-395.
  4. Bado JL. “The Monteggia lesion”. Clinical Orthopaedics and Related Research 50 (1967): 71-86.
  5. Noonan KJ and Price CT. “Forearm and distal radius fractures in children”. Journal of the American Academy of Orthopaedic Surgeons 3 (1998): 146-156.
  6. Kay RM and Skaggs DL. “The pediatric Monteggia fracture”. American Journal of Orthopedics (Belle Mead NJ) 9 (1998): 606-609.
  7. Ring D., et al. “Monteggia fractures in children and adults”. Journal of the American Academy of Orthopaedic Surgeons 4 (1998): 215-224.
  8. Gleeson AP and Beattie TF. “Monteggia fracture-dislocation in children”. Journal of Accident and Emergency Medicine 11 (1994): 192-194.
  9. Letts M., et al. “Monteggia fracture-dislocations in children”. Journal of Bone and Joint Surgery. British Volume 5 (1985): 724-727.
  10. Stoll TM., et al. “Treatment of the missed Monteggia fracture in the child”. Journal of Bone and Joint Surgery. British Volume3 (1992): 436-440.
  11. Bell-Tawse AJS. “The treatment of malunited anterior monteggia fractures in children”. Journal of Bone and Joint Surgery. British Volume4 (1965): 718-723.
  12. Lloyd-Roberts GC and Bucknill TM. “Anterior dislocation of the radial head in children”. Journal of Bone and Joint Surgery. British Volume4 (1977): 402-407.
  13. Hurst LC and Dubrow EN. “Surgical treatment of symptomatic chronic radial head dislocation: a neglected Monteggia fracture”. Journal of Pediatric Orthopaedics 2 (1983): 227-230.
  14. Steel MJ and Peterson HA. “Management of chronic posttraumatic radial head dislocation in children”. Journal of Pediatric Orthopaedics 3 (1999): 306-312.
  15. Kalamchi A. “Monteggia fracture dislocation in children”. Journal of Bone and Joint Surgery. American Volume 68-A.4 (1986): 615-619.
  16. Freedman L., et al. “Radial head reduction after missed monteggia fracture Brief report”. Journal of Bone and Joint Surgery. British Volume 70-B.5 (1988): 846-847.
  17. Lincoln TL and Mubarak SJ. “Isolated traumatic radial-head dislocation”. Journal of Pediatric Orthopaedics 4 (1994): 454-457.
  18. Morrey BF. “The elbow and its disorders, 3rd edition”. Philadelphia: WB Sanders (2000): 262-281.
  19. Speed and Boyd. “Fractures and dislocations in children”. Campbell’s operative orthopaedics (2013).
  20. Kim HT., et al. “Chronic radial head dislocation in children, Part 2: results of open treatment and factors affecting final outcome”. Journal of Pediatric Orthopaedics5 (2002): 591-597.
  21. McFarland B. “Congenital dislocation of head of radius”. British Journal of Surgery 93 (1936): 41-49.
  22. Stans AA and Heinrich SD. “Dislocations of the elbow”. In: Beaty JH and Kasser JR editors. Rockwood And Green’s Fracture in children. Philadelphia: Lippincott Williams &Wilkins, volume 2 (6th edition) (2006): 661-701.
  23. Lincoln TL and Mubarak SJ. “Isolated traumatic radial-head dislocation”. Journal of Pediatric Orthopaedics4 (1994): 454-457.
  24. Stanley D. “Isolated traumatic anterior dislocation of the radial head-a mechanism of injury in children”. Injury 3 (1986): 182-183.
  25. Good CJ and Wicks MH. “Developmental posterior dislocation of the radial head”. Journal of Bone and Joint Surgery. British Volume1 (1983): 64-65.
  26. Kemnitz S., et al. “Radial head dislocation with plastic deformation of the ulna in children. A rare and frequently missed condition”. Acta Orthopaedica Belgica 4 (2000): 359-362.
  27. Sachar K and Mih AD. “Congenital radial head dislocations”. Hand Clinics1 (1998): 39-47.
  28. Chambers HG and Wilkins KE. “Dislocation of the head of the radius”. In: Rockwood CA Jr, Wilkins KE, Beaty JH, eds. Fractures in Children. Philadelphia, New York: Lippincott-Raven (1996): 873-878.
  29. Bae Donald S. “Successful strategies for managing monteggia injuries”. Journal of Pediatric Orthopaedics1 (2016): S67-S70.
  30. Dormans JP and Rang M. “The problem of Monteggia fracture-dislocations in children”. Orthopedic Clinics of North America 2 (1990): 251-256.
  31. Best TN. “Management of old unreduced Monteggia fracture dislocations of the elbow”. Journal of Pediatric Orthopaedics2 (1994): 193-199.
  32. Garg R., et al. “Surgical management of radial head dislocation in quadriplegic cerebral palsy-a 5 year follow-up”. Journal of Hand Surgery (European Volume) 6 (2007): 725-726.
  33. Eygendaal D and Hillen RJ. “Open reduction and corrective ulnar osteotomy for missed radial head dislocations in children”. Strategies in Trauma and Limb Reconstruction 1 (2007): 31-34.
  34. Inoue G and Shionoya K. “Corrective ulnar osteotomy for malunited anterior Monteggia lesions in children. 12 patients followed for 1-12 years”. Acta Orthopaedica Scandinavica 1 (1998): 73-76.
  35. Jupiter JB., et al. “Reconstruction of posttraumatic disorders of the forearm”. Journal of Bone and Joint Surgery. American Volume11 (2009): 2730-2739.
  36. Degreef I and De Smet L. “Missed radial head dislocations in children associated with ulnar deformation: treatment by open reduction and ulnar osteotomy”. Journal of Orthopaedic Trauma 6 (2004): 375-378.
  37. Nakamura K., et al. “Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children”. Journal of Bone and Joint Surgery. American Volume6 (2009): 1394-1404.
  38. Oner FC and Diepstraten AF. “Treatment of chronic post-traumatic dislocation of the radial head in children”. Journal of Bone and Joint Surgery. British Volume4 (1993): 577-581.
  39. Hirayama T., et al. “Operation for chronic dislocation of the radial head in children. Reduction by osteotomy of the ulna”. Journal of Bone and Joint Surgery. British Volume4 (1987): 639-642.
  40. Horii E., et al. “Surgical treatment for chronic radial head dislocation”. Journal of Bone and Joint Surgery. American Volume7 (2002): 1183-1188.
  41. Hannouche D and Begue T. “Functional anatomy of the lateral collateral ligament complex of the elbow”. Surgical and Radiologic Anatomy 3 (1999): 187-191.
  42. Gyret BM., et al. “Chronic Monteggia fractures in children: outcome after treatment with the BellTawse procedure”. Journal of Pediatric Orthopaedics B 6 (2004): 402-406.
  43. Inoue G and Shionoya K. “Corrective ulnar osteotomy for malunited anterior Monteggia lesions in children. 12 patients followed for 1-12 years”. Acta Orthopaedica Scandinavica 1 (1998): 73-76.
  44. Hasler CC., et al. “Open reduction, ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius”. Journal of Bone and Joint Surgery. British Volume1 (2005): 88-94.
  45. Lu X., et al. “Management of missed Monteggia fractures with ulnar osteotomy, open reduction, and dual-socket external fixation”. Journal of Pediatric Orthopaedics 4 (2013): 398-402.
  46. Oner FC and Diepstraten AF. “Treatment of chronic post-traumatic dislocation of the radial head in children”. Journal of Bone and Joint Surgery. British Volume4 (1993): 577-581.
  47. Best TN. “Management of old unreduced Monteggia fracture dislocations of the elbow”. Journal of Pediatric Orthopaedics 2 (1994): 193-199.
  48. Nakamura K., et al. “Long term clinical and radiographic outcomes aіeropen reduction for missed Monteggia fracture-dislocations in children”. Journal of Bone and Joint Surgery. American Volume6 (2009): 1394-1404.
  49. David-West KS., et al. “Missed monteggia injuries”. Injury10 (2005): 1206-1209.
  50. Bouyala JM., et al. “The treatment of old dislocations of the radial head in children by osteotomy of the upper end of the ulna. Apropos of 15 cases”. Revue de Chirurgie Orthopedique et Reparatrice de l'Appareil Moteur 2 (1988): 173-182.
  51. Bhojraj SD. “Surgical correction of malunited Monteggia fractures in children”. Indian Journal of Orthopaedics 2 (1981): 138-144.
  52. Freedman L., et al. “Radial head reduction after missed monteggia fracture Brief report”. Journal of Bone and Joint Surgery. British Volume 70-B.5 (1988): 846-847.
  53. Fowles JV., et al. “The Monteggia lesion in children. Fracture of the ulna and dislocation of the radial head”. Journal of Bone and Joint Surgery. American Volume9 (1983): 1276-1282.
  54. Attarian D. “Annular ligament reconstruction in chronic posttraumatic radial head dislocation in children”. Contemporary Orthopaedics 3 (1993): 259-264.
  55. Tan JW., et al. “Pathology of the annular ligament in paediatric Monteggia fractures”. Injury 4 (2008): 451-455.
  56. Wang MN and Chang WN. “Chronic posttraumatic anterior dislocation of the radial head in children: thirteen cases treated by open reduction, ulnar osteotomy, and annular ligament reconstruction through a Boyd incision”. Journal of Orthopaedic Trauma 1 (2006): 1-5.
  57. Bor N., et al. “Chronic anterior monteggia lesions in children: report of 4 cases treated with closed reduction by ulnar osteotomy and external fixation”. Journal of Pediatric Orthopaedics 1 (2015): 7-10.
  58. Ray R and Gaston M. “Treatment of late-presenting Monteggia variant with an isolated, simple flexion ulnar osteotomy”. Journal of Pediatric Orthopaedics B 5 (2014): 472-476.

Nguyen Ngoc Hung. "Ulnar Osteotomy, Recontructe Annular Ligament by Fascia Lata for Neglected Monteggia Fracture Dislocation in Children." EC Orthopaedics 15.10 (2024): 01-24.

ECronicon Journal

Our Services

Quick Links

Information

Creative Commons LicenseOpen Access by ECronicon is licensed under a Creative Commons Attribution 4.0 International License
Based on a work at www.ecronicon.net