Outcome of Monteggia Fracture Dislocation in Children Treated With K Wires in Nepalgunj Medical College

Introduction: Monteggia fracture dislocations are rare injuries (<5%) where missed treatment results into deformity and dysfunction of forearm and hand. For the better functional result early diagnosis, accurate reduction of radial head and rigid fixation of ulna and immobilization during post-operative period for ligamentous healing around radius is vital. So operative treatment has been the primary method of treatment to prevent deformity and disability in monteggia fracture dislocation. Aims: The aim of this study was to evaluate the time taken to unite fractures, complications encountered and assess the functional outcome on the basis of K-wire fixation in monteggia fracture dislocation in children. Methods: A cross-sectional observational study was conducted in Nepalgunj Medical College and Teaching Hospital, Kohalpur, Banke with monteggia fracture dislocation in children. Results: Thirty-two monteggia fracture dislocation in children between six to 14 years of age were treated with intramedullary K-wires after reduction of radial head. Seven cases had open reduction, and five needed trans-capitellar K-wire supplementation. Mean union time was 8.44±1.94 weeks ranging from seven to 12 weeks. The functional outcome on the basis of Anderson’s scoring system was excellent in 25(78.1%), good in three and optimal in four cases. Conclusion: Monteggia fracture dislocation is better treated early and early mobilization of elbow joint is needed for better functional results.

A Novel Case of Neglected Monteggia Fracture Dislocation

Background: The Monteggia fracture-dislocation is a rare condition among children, and its treatment is still controversial. The treatment can become quite complicated when the diagnosis is delayed. There is a broad range of surgical treatments with various complications like subluxations, degenerative changes, and radial head deformity. The present case was reported as a novel surgical treatment choice for neglected Monteggia fracture-dislocation. Case Report: A 16 year-old boy presented with left elbow severe range of motion (ROM) limitation and pain who was diagnosed with neglected Monteggia fracture-dislocation. The patient went through open reduction beside internal fixation of the ulnar shaft via Limited Contact Dynamic Compression Plate (LC-DCP) and radio-capitellar joint reduction and provisional fixation by a pin. The patient recovered after three months with a significant increase in elbow ROM without any complications. Conclusion: This method could be an appropriate treatment of choice for neglected Monteggia fractures which indeed had excellent outcomes without complication.

A New Pediatric Monteggia Fracture Type 4 Variant

Introduction: Monteggia fracture-dislocations are rare and complex injuries that usually involve a fracture of the proximal ulna associated with a proximal radioulnar and radiocapitellar joint dislocations. These injuries comprise <1% of all pediatric forearm fractures. We report on a pediatric Monteggia fracture-dislocation variant that included an irreducible divergent ulnohumeral joint dislocation, an irreducible anterior radial head dislocation, and a proximal and distal radius and ulna fracture. Case Report: A 6-year-old female came to our emergency room with a right elbow and forearm pain and deformity after a fall from a slide on the same day. X-rays revealed a divergent ulnohumeral joint dislocation, an anterior radiocapitellar joint dislocation, a proximal radioulnar joint dislocation, and a proximal and distal ulna and radius fracture. Closed reduction under sedation in the emergency room was not successful, with persistent ulnohumeral, ulnoradial, and radiocapitellar joint dislocations. The patient was taken to the operating room the next morning. She underwent open reduction and internal fixation of the proximal ulna fracture with a one-third tubular locking plate, and radial head dislocation open reduction. A stable reduction of the ulnohumeral joint was only possible after the fixation of the proximal ulna fracture. The most stable position for the radiocapitellar joint after its open reduction was at 70o of elbow extension and full forearm supination; the patient was casted in that position for 6 weeks. Conclusion: Pediatric Monteggia fracture-dislocations are rare and complex childhood fractures, and new variants of this injury can have even more complex presentations. Open reduction and stable internal fixation addressing all components of this injury will lead to an excellent outcome. Keywords: Pediatric monteggia fracture-dislocation, new type four variant, divergent ulnohumeral joint dislocation, irreducible dislocation.

Monteggia Fracture-Dislocation with Associated TFCC Injury and DRUJ Subluxation – A Very Rare Case Report

Introduction:Monteggia fracture-dislocation is defined as a proximal third ulna fracture with radiocapitellar joint dislocation. The term “Monteggia equivalent or variant” describes various injuries with similar radiographic patterns and injury biomechanics. Several isolated cases of unusual injuries associated with Monteggia fractures have been reported. However, an associated TFCC injury has not been described in the literature before. We present a rare report of a 24-year-old female with a Monteggia fracture and associated TFCC injury – a crisscross type of injury. Case Report:A 24-year-old female was involved in a road traffic accident and presented to our level I trauma center with pain and deformity in the left forearm. On evaluation, she was found to have type I Monteggia fracture-dislocation. Intraoperatively, once the proximal ulna was fixed, she had clicking in the wrist during rotations. Fluoroscopic images showed DRUJ subluxation, but it was stable in supination. Hence was splinted in a reduced position. The patient continued to have persistent symptoms in the wrist despite adequate conservative measures. Hence, she underwent arthroscopic TFCC repair and DRUJ pinning. At her last follow-up (3 months), the patient was clinically better with a good range of motion and no pain. Conclusion:In treating Monteggia fracture-dislocations, high index of suspicion is needed to diagnose radioulnar joint instability. If they are missed, they can result in long-term disability, so appropriate evaluation to diagnose TFCC and DRUJ injuries is required. DRUJ stabilization and TFCC repair can produce consistent results when treated adequately. Keywords:TFCC, monteggia, wrist, arthroscopy, proximal ulna.

Successful Treatment of Chronic Monteggia Fracture-dislocations in Children---A New Reference

BackgroundGreat difficulty and more failures were the descriptions of a chronic Monteggia fracture-dislocation. The treatment of chronic Monteggia lesion remains controversial and challenging for surgeons. This study aims to introduce our experience of a new reference in the treatment of chronic Monteggia fracture-dislocation in children and evaluate outcomes from clinical and radiographic findings.MethodsWe retrospectively reviewed 18 children who underwent surgical treatment because of chronic Monteggia lesion. Electronic medical records of clinical data, radiographic parameters, and operative details, were reviewed for study analysis. Parameters were compared at the time of pre-operation and the last follow-up. The relationship of lengthening and angulation of ulnar was calculated.ResultsMean interval time was 11.1 ± 15.7 months and follow-up time was 34.6 ± 23.7 months in this study. A congruent radiocapitellar reduction was observed in 15 (83.3%) patients, while 2 (11.1%) patients developed subluxation, and 1 (5.6%) patient had redislocation. The mean posterior bending angle was 12.88° (range, 3 to 25°), and the mean amount of elongation of the ulnar was 8.78 mm (range, 3.6 to 17.5 mm). The lengthening was significantly proportional to the magnitude of angulation of ulnar in good outcome patients (r = 0.637, p = 0.009), and the index was larger than the failed ones. Postoperatively, the Kim scores were obviously improved, from 59.17 ± 18.17 to 90 ± 6.64.ConclusionsWe highlight the ulnar osteotomy as the essential procedure during the reconstruction surgeries. Enough elongation and balanced angulation of the osteotomy is warranted to keep satisfactory outcomes. The ulnar should be lengthened to more than normal proportional ulnar length to stable the radial head reduction. Iliac crest autograft is recommended to avoid nonunion of ulnar osteotomy after enough lengthening.Level of evidenceLevel IV; Case Series; Treatment Study