scholarly journals Surgical treatment of chronic anterior radial head dislocations in missed Monteggia lesions in children: A rationale for treatment and pearls and pitfalls of surgery

2019 ◽  
Vol 12 (6) ◽  
pp. 422-431
Author(s):  
LC Langenberg ◽  
ACH Beumer ◽  
B The ◽  
KLM Koenraadt ◽  
D Eygendaal
Keyword(s):  
Range Of Motion ◽  
Radial Head ◽  
Ligament Reconstruction ◽  
Annular Ligament ◽  
Proximal Ulna ◽  
Monteggia Lesion ◽  
Ulna Osteotomy ◽  
Annular Ligament Reconstruction ◽  
Monteggia Lesions ◽  
Missed Monteggia

Introduction The treatment of chronic radial head dislocations after Monteggia lesions in children can be challenging. This article provides a detailed description of the most frequently performed surgical technique: an ulna osteotomy followed by annular ligament reconstruction. Accordingly, we present the clinical and radiological results of 10 paediatric cases. Material and methods All paediatric patients that had a corrective osteotomy of the ulna for a missed Monteggia lesion between 2008 and 2014 were evaluated with standard radiographs and clinical examination. A literature search was performed to identify the relevant pearls and pitfalls of surgery. Primary outcome was range of motion. Results We included 10 patients, with a mean follow-up of 2.5 years. Postoperative range of motion generally improved 30.7°. Even in a patient with obvious deformity of the radial head, range of motion improved after surgery, without residual dislocation of the radial head. Conclusion Corrective proximal ulna osteotomy with rigid plate fixation and annular ligament reconstruction yields good results in patients with chronic radial head dislocation following a Monteggia lesion. Surgery should be considered regardless of patient age or time since trauma. Given substantial arguments in literature, we discourage surgery if a CT scan shows dome-shaped radial head dysmorphic features in work-up to surgery.

scholarly journals Step-cut osteotomy in neglected Monteggia fracture dislocation in pediatric and adolescent patients: A retrospective study

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902096408
Author(s):  
Chetan Peshin ◽  
Rohan Ratra ◽  
Anil Kumar Juyal
Keyword(s):  
Retrospective Study ◽  
Range Of Motion ◽  
Radial Head ◽  
Bone Grafting ◽  
Ligament Reconstruction ◽  
Fracture Dislocation ◽  
Annular Ligament ◽  
Monteggia Fracture ◽  
Annular Ligament Reconstruction ◽  
Monteggia Fracture Dislocation

Introduction: Neglected Monteggia fracture dislocation in children leads to significant restriction of daily activities by causing decreased range of motion at elbow, stiffness, deformity, and neurological compromise. Various treatment strategies have been described in the literature and one of them is ulnar osteotomy combined with reduction of radial head and annular ligament reconstruction. Aim: The aim of this study was to evaluate the results of step-cut osteotomy without the use of bone grafting with reconstruction of annular ligament in the management of neglected Monteggia fracture dislocation in children. Materials and Methods: A retrospective study was conducted in six patients with neglected Monteggia fracture dislocation with a mean age of 8.83 years. The median interval between the original injury and the corrective surgery for 6 patients was 4.4 months (range 1–12 months). All children underwent step-cut osteotomy of ulna, open reduction of radial head, and annular ligament reconstruction. Mayo Elbow Performance Index (MEPI) score was used for evaluation. Results: The ulnar osteotomies healed uneventfully without the need for a bone graft. Elbow range of motion improved post-op along with improved elbow functioning as indicated by raised MEPI score. The MEPI score was excellent in 5 cases and fair in 1 case. Conclusion: Step-cut osteotomy alone without the use of bone grafting and reinforcement with annular ligament repair is a simple yet effective technique for treating neglected Monteggia fracture dislocation.

scholarly journals Treatment of missed Monteggia lesion in children: Case report

2011 ◽  
Vol 139 (1-2) ◽  
pp. 99-102
Author(s):  
Zoran Vukasinovic ◽  
Vesna Jovanovic ◽  
Desanka Mitrovic ◽  
Nemanja Slavkovic
Keyword(s):  
Radial Head ◽  
Treatment Process ◽  
Annular Ligament ◽  
Ilizarov Method ◽  
Radial Head Dislocation ◽  
Bone Maturation ◽  
Joint Opening ◽  
Monteggia Lesion ◽  
Lesion Type ◽  
Missed Monteggia

Introduction. A Monteggia lesion is a dislocation of the radial head associated with a fracture with the proximal third of the ulna. It is rare in children and the dislocation of the radial head is often missed at the time of injury. There are a lot of described treatment methods: open reduction of the radial head and reconstruction of the annular ligament combined with ulnar osteotomy, the same method without reconstruction of the annular ligament, gradual lengthening and angulation of the ulna by Ilizarov method without the opening of radiocapitelar joint. Case Outline. A 14-year-old boy had been diagnosed with Monteggia lesion type Bado II three years before the admission to hospital. Previously nonoperatively treated, the missed radial head dislocation Bi-phase treatment had been done. Firstly, the distraction Ilizarov device was placed on the forearm, corticotomy of the ulna was done, distraction lasted fifteen days. Secondly, after achieving 1.5 cm of new bone and good level of the radial head, a reduction mechanism was incorporated into the Ilizarov device. The radiocapitelar joint was not opened, the reconstruction of the annular ligament was not done. After the radial head reduction and new bone maturation (1.5 months), the Ilizarov device was taken off. Conclusion. The described method of treatment has several important advantages: radial head reduction may be done without the joint opening, the recovery is very fast and easy after that; the elbow and forearm appear cosmetically very well after the operation; the treatment process is short, the arm is in use all the time, the absence from school is not needed, the achieved result is permanent.

A modified Bell-Tawse Proceduter for surgical correction of congenital elbow luxation in a Dalmatian puppy

2001 ◽  
Vol 14 (04) ◽  
pp. 210-213 ◽  
Author(s):  
N. Romagnoli ◽  
A. Venturini ◽  
A. Spadari
Keyword(s):  
Contact Surface ◽  
Radial Head ◽  
Ligament Reconstruction ◽  
Weight Bearing ◽  
Surgical Correction ◽  
Annular Ligament ◽  
Orthopaedic Procedure ◽  
Elbow Luxation ◽  
Annular Ligament Reconstruction ◽  
The Right

SummaryA four month old Dalmatian puppy affected by congenital luxation of the radial head was very lame on the right front limb and was not weight bearing after little exercise. The radiological examination revealed humero-radial articular incongruity, excessive humeral trochlea development, trochlear notch deformation, and medial deviation of the olecranon. The surgery performed was derived from a modification of a human orthopaedic procedure, the Bell-Tawse technique. It was intended to increase the articular contact surface between the humerus and radius, with ostectomy, rotation, and osteosynthesis of the radius; to treat the luxation, by reduction and elbow annular ligament reconstruction; to prevent its recurrence, by means of a Kirschner pin inserted through the lateral humeral epicondyle to the radial head. Over six months the patient completely recovered.A congenital luxation of the radial head in a puppy was treated successfully employing a technique reported in human orthopaedics.

Open Reduction of the Radial Head with Ulnar Osteotomy and Annular Ligament Reconstruction for Bilateral Congenital Radial Head Dislocation: A Case with Long-Term Follow-Up

2007 ◽  
Vol 32 (1) ◽  
pp. 93-97 ◽  
Author(s):  
H. YAMAZAKI ◽  
H. KATO
Keyword(s):  
Radial Head ◽  
Open Reduction ◽  
Ligament Reconstruction ◽  
Annular Ligament ◽  
Radial Head Dislocation ◽  
Results Of Treatment ◽  
Ulnar Osteotomy ◽  
Annular Ligament Reconstruction ◽  
Congenital Radial Head Dislocation

We report the 9 year follow-up results of treatment of a 5 year-old boy with bilateral congenital radial head dislocation by open reduction of the radial head and ulnar osteotomy with annular ligament reconstruction and discuss the management of this condition.

scholarly journals Angulating-Distraction Ulnar Osteotomy and Interpositional Phosphocalcic Ceramic Wedge Graft for a Chronic Monteggia Lesion

2017 ◽  
Vol 11 (1) ◽  
pp. 263-267
Author(s):  
Jagadish Prabhu ◽  
Mohammed K. Faqi ◽  
Fahad AL Khalifa ◽  
Rashad K. Awad
Keyword(s):  
Radial Head ◽  
Donor Site ◽  
Early Mobilization ◽  
Donor Site Morbidity ◽  
Annular Ligament ◽  
Osteotomy Site ◽  
Rigid Fixation ◽  
Monteggia Lesion ◽  
Ulnar Osteotomy ◽  
Annular Ligament Reconstruction

Background: Various types of osteotomies have been used to facilitate reduction of the radial head and to prevent recurrent subluxation. The Bouyala technique – open reduction of radial head associated with open wedge ulnar osteotomy with or without annular ligament reconstruction, is presently the most widely used treatment for long- standing traumatic dislocation of the radial head, independently of age, in the absence of osteoarthritis remodeling, and should preferably be performed within 1 year of trauma. Method: In this article, we present a similar case operated by same technique, but we used synthetic phosphocalcic ceramic wedge graft instead of auto bone graft as described in many other studies. We believe that, this will limit the donor site morbidity and also aid in achieving better stability at osteotomy site, which in turn help in proceeding with early active mobilization protocol. Result: We achieved union of the osteotomy by three months. Clinically, there was no deformity and she achieved full pain-free range of motion of elbow joint. Conclusion: We believe that, use of synthetic phosphocalcic ceramic wedge graft allow rigid fixation of osteotomy, provides additional stability, decrease the risk of secondary displacement and allow early mobilization, which may minimize contracture and we could achieve fairly good clinical outcome.

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

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094907
Author(s):  
Weizheng Zhou ◽  
Lianyong Li ◽  
Mingzhang Mu
Keyword(s):  
Functional Outcomes ◽  
Open Reduction ◽  
Ligament Reconstruction ◽  
Annular Ligament ◽  
Monteggia Fracture ◽  
Mature Individual ◽  
Initial Injury ◽  
Annular Ligament Reconstruction ◽  
Missed Monteggia

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.

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