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.

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 Surgical treatment in children missed Monteggia lesions at Bhuj, Kutch, Gujarat: a retrospective study

2016 ◽  
Vol 3 (1) ◽  
pp. 30 ◽  
Author(s):  
Prakash Chauhan
Keyword(s):  
Internal Fixation ◽  
Radial Head ◽  
Medical Science ◽  
Surgical Techniques ◽  
Annular Ligament ◽  
Osteotomy Site ◽  
Cast Immobilization ◽  
Monteggia Lesion ◽  
Ulnar Osteotomy ◽  
Chronic Dislocation

<p class="abstract"><strong>Background:</strong> The treatment of an unrecognized Monteggia lesion continues to pose a therapeutic challenge, as evidenced by the variety of surgical techniques described. Moreover, there are high complication and redislocation rates following surgery. This report concerns a surgical technique to reduce a chronic dislocation of the radial head utilizing an ulnar osteotomy and internal fixation<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Present study was performed at department of orthopedics, Gujarat Adani institute of medical science, Bhuj, Kutch, Gujarat. Ethical clearance was taken from the institutional ethics board and informed consent was obtained from all the participants. Between July 2015 and September 2016 six children presented in a traumatic context with chronic dislocation of the radial head and malunion of the ulna.  Patient mean age was 6.5 (range 4–8) years, and the mean interval between injury and surgical procedure was 17 (range 1–49) months. Surgery consisted of an ulnar osteotomy with angulation and lengthening, bone grafting at the osteotomy site, and internal fixation. Open reduction of the radial head, repair or reconstruction of the annular ligament or temporary fixation of the radial head with a transarticular wire was not undertaken. Cast immobilization with the forearm in neutral rotation was maintained for 4-6 weeks.<strong></strong></p><p class="abstract"><strong>Results:</strong> There was one case of nonunion. At an average follow-up of 3 (range 1.5–4.4) years, all patients had regained painless function of the forearm, good range of elbow and forearm motion, and maintenance of the radial head reduction<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Both angulation and elongation of the ulna are required to allow for reduction of the radial head. We do not see any indication for procedures directed at the radio-capitellar joint<span lang="EN-IN">.</span></p>

scholarly journals Isolate and irreducible radial head dislocation in children: a rare case of capsular interposition

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Luigi Tarallo ◽  
Michele Novi ◽  
Giuseppe Porcellini ◽  
Fabio Catani
Keyword(s):  
Radial Head ◽  
Soft Tissues ◽  
Biceps Tendon ◽  
Annular Ligament ◽  
Neutral Position ◽  
Radial Head Dislocation ◽  
Anterior Capsule ◽  
Associated Lesions ◽  
Sport Activities ◽  
Tendon Interposition

Abstract Background Radial head dislocation with no associated lesions, is a relatively uncommon injury in children. In this case report, it is reported a case of anteromedial locked radial head dislocation in children, and we discuss its clinical presentation and pathogenetic mechanism of injury. Case presentation An 8-year-old girl fell off on her right forearm with her right elbow extended in hyperpronation. An isolated radio-capitellar dislocation was identified with no other fractures or neurovascular injuries associated. Elbow presented an extension-flexion arc limited (0°- 90°), and the prono-supination during general anesthesia shows “a sling effect” from maximal pronation (+ 55°) and supination (+ 90°) to neutral position of forearm. The radial head dislocation was impossible to reduce and an open reduction was performed using lateral Kocher approach. The radial head was found “button-holed” through the anterior capsule. The lateral soft tissues were severely disrupted and the annular ligament was not identifiable. Only by cutting the lateral bundle of the capsule was possible to reduce the joint. At 50 moths follow-up, patient presented a complete Range of motion (ROM), complete functionality and no discomfort or instability even during sport activities. Discussion and conclusion It is important to understand the pathogenic mechanisms of locked radial head dislocation in children. Some mechanism described are the distal biceps tendon or the brachialis tendon interposition. However even the anterior capsule can hinder reduction. A characteristic “sling-effect” of the forearm could be pathognomonic for capsular button-holing. Surgical release of the capsular bundle sometimes is the only way to reduce the dislocation and obtain a good outcome.

RADIAL HEAD DISLOCATION AS A RARE COMPLICATION OF OBSTETRIC BRACHIAL PLEXUS PALSY: LITERATURE REVIEW AND FIVE CASE SERIES

Hand Surgery ◽  
2012 ◽  
Vol 17 (01) ◽  
pp. 33-36 ◽  
Author(s):  
Cecilia W. Huo
Keyword(s):  
Brachial Plexus ◽  
Radial Head ◽  
Biceps Tendon ◽  
Rare Complication ◽  
Case Series ◽  
Annular Ligament ◽  
Radial Head Dislocation ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus

Radial head dislocation secondary to obstetric brachial plexus palsy is a rare complication that may occur a few years after birth. Five cases were examined and a comprehensive literature search was performed. Although it is a concern for parents, the dislocation resulted in mild or minimal functional impairment for all five children. Surgical interventions such as biceps tendon transfer, radial head open reduction or excision and annular ligament reconstruction were largely ineffective in significantly improving ranges of motion. Clinicians should be aware of the potentially futile outcomes and risks associated with the surgical treatment of radial head dislocation.

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.

Missed Monteggia fracture dislocations treated by open reduction of the radial head

2018 ◽  
Vol 100-B (8) ◽  
pp. 1117-1124 ◽  
Author(s):  
P. Eamsobhana ◽  
O. Chalayon ◽  
K. Kaewpornsawan ◽  
T. Ariyawatkul
Keyword(s):  
Radial Head ◽  
Open Reduction ◽  
Univariate Analysis ◽  
Fracture Dislocation ◽  
Annular Ligament ◽  
Monteggia Fracture ◽  
Radiological Outcome ◽  
Monteggia Lesion ◽  
Initial Injury ◽  
The Mean

Aims Delayed diagnosis is a well-known complication of a Monteggia fracture-dislocation. If left untreated, the dislocated radial head later becomes symptomatic. The purposes of this study were firstly, to evaluate the clinical and radiological results of open reduction of the radial head and secondly, to identify the factors that may affect the outcome of this procedure. Materials and Methods This retrospective study evaluated 30 children with a chronic Monteggia lesion. There were 18 boys and 12 girls with a mean age of 7.4 years (4 to 13) at the time of open reduction. The mean interval to surgery, after the initial fracture, was 23.4 months (6 to 120). Clinical grading used a Kim modified elbow score: radiological outcome was recorded. The effect of the patient’s age, gender, duration from initial injury, Bado classification, and annular ligament reconstruction were analyzed. The mean follow-up was 42.2 months (15 to 20). Results The Kim elbow scores evaluated at the last clinic visit were excellent in 23 patients, good in three, fair in two, and poor in two. A majority of the patients were found to have significant improvement of elbow flexion (p < 0.001). Six met the criteria of a fair radiological outcome; four of these were operated on more than 24 months after the initial injury, and three had surgery after the age of 11. Univariate analysis failed to find any factor that was significantly associated with a fair or poor outcome. Conclusion Good clinical and radiological outcomes can be expected in most patients. Osteoarthritic changes were associated with age > 11 years and/or a delay of treatment of > 24 months. However, no statistically significant factor could be identified which correlated with an unfavourable outcome. Cite this article: Bone Joint J 2018;100-B:1117–24.

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