Open Reduction and Corrective Ulnar Osteotomy for Missed Radial Head Dislocations in Children

Overview

Journal Strategies Trauma Limb Reconstr

Date 2008 Apr 23

PMID 18427912

Citations 12

Authors

D Eygendaal

R J Hillen

Affiliations

Soon will be listed here.

Abstract

The treatment of chronic radial head dislocation remains controversial. Open reduction of the radial head in combination with correction of malalignment with ulnar osteotomy can be the key to a good surgical result. Between 2001 and 2006, 9 (6 female, 3 male, average age 8.4 (5-11) years) patients were treated surgically for chronic radial head dislocation by one surgeon. The time between trauma and surgery was 7 (1.5-14) months. The procedure consisted of open reduction of the dislocated radial head and reconstruction of the annular ligament in combination with an ulnar osteotomy. An upper arm cast was applied with the forearm in neutral rotation for six weeks. Plates were removed in all patients. Clinical and radiological evaluation took place preoperatively and after an average of 23 (10-49) months. At radiograph 8/9 showed a reduced radial head; in one an anterior subluxation was seen. The range of motion remained the same in 4 patients who had a full range of motion preoperatively. In 2/5 patients with loss of range of motion preoperatively, improvement was seen. There were no serious surgical complications beside one infection. Open reduction and corrective ulnar osteotomy shows good results for missed radial head dislocations in children.

Citing Articles

Radial head volume measurements using quantitative three-dimensional computed tomography images for radial head deformation following missed Monteggia lesions.

Langenberg L, Janssen S, Eygendaal D JSES Int. 2023; 7(6):2612-2616.

PMID: 37969504 PMC: 10638549. DOI: 10.1016/j.jseint.2022.10.011.

Neglected Monteggia Fracture Dislocations in Children: A Case Series.

Alajmi T J Orthop Case Rep. 2021; 10(7):57-62.

PMID: 33585318 PMC: 7857649. DOI: 10.13107/jocr.2020.v10.i07.1918.

Anterior Dislocation of the Radial Head Combined with Plastic Deformity of the Ulnar Shaft in an Adult: A Case Report.

Moon S, Kim Y, Kim Y, Kim J, Yoon T, Kim S Clin Shoulder Elb. 2020; 21(1):42-47.

PMID: 33330150 PMC: 7726371. DOI: 10.5397/cise.2018.21.1.42.

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

Langenberg L, Beumer A, The B, Koenraadt K, Eygendaal D Shoulder Elbow. 2020; 12(6):422-431.

PMID: 33281947 PMC: 7689610. DOI: 10.1177/1758573219839225.

CHRONIC MONTEGGIA FRACTURE-DISLOCATION IN CHILDREN SURGICAL STRATEGY AND RESULTS.

Soni J, Valenza W, Matsunaga C, Costa A, Faria F Acta Ortop Bras. 2019; 27(5):244-247.

PMID: 31839731 PMC: 6901151. DOI: 10.1590/1413-785220192705215273.

References

Bell Tawse A . The treatment of malunited anterior Monteggia fractures in children. J Bone Joint Surg Br. 1965; 47(4):718-23. View

Best T . Management of old unreduced Monteggia fracture dislocations of the elbow in children. J Pediatr Orthop. 1994; 14(2):193-9. DOI: 10.1097/01241398-199403000-00012. View

Kim H, Park B, Suh J, Yoo C . Chronic radial head dislocation in children, Part 2: results of open treatment and factors affecting final outcome. J Pediatr Orthop. 2002; 22(5):591-7. View

Oner F, Diepstraten A . Treatment of chronic post-traumatic dislocation of the radial head in children. J Bone Joint Surg Br. 1993; 75(4):577-81. DOI: 10.1302/0301-620X.75B4.8331112. View

Kim H, Conjares J, Suh J, Yoo C . Chronic radial head dislocation in children, Part 1: pathologic changes preventing stable reduction and surgical correction. J Pediatr Orthop. 2002; 22(5):583-90. View

Chen W . Late neuropathy in chronic dislocation of the radial head. Report of two cases. Acta Orthop Scand. 1992; 63(3):343-4. DOI: 10.3109/17453679209154798. View

Dormans J, Rang M . The problem of Monteggia fracture-dislocations in children. Orthop Clin North Am. 1990; 21(2):251-6. View

Morrey B, Tanaka S, An K . Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res. 1991; (265):187-95. View

BOYD H, Boals J . The Monteggia lesion. A review of 159 cases. Clin Orthop Relat Res. 1969; 66:94-100. View

10.

Hirayama T, Takemitsu Y, Yagihara K, Mikita A . Operation for chronic dislocation of the radial head in children. Reduction by osteotomy of the ulna. J Bone Joint Surg Br. 1987; 69(4):639-42. DOI: 10.1302/0301-620X.69B4.3611173. View

11.

Koslowsky T, Mader K, Wulke A, Gausepohl T, Pennig D . Operative treatment of chronic Monteggia lesion in younger children: a report of three cases. J Shoulder Elbow Surg. 2006; 15(1):119-21. DOI: 10.1016/j.jse.2004.12.002. View

12.

Ring D, Waters P . Operative fixation of Monteggia fractures in children. J Bone Joint Surg Br. 1996; 78(5):734-9. View

13.

Freedman L, Luk K, Leong J . Radial head reduction after a missed Monteggia fracture: brief report. J Bone Joint Surg Br. 1988; 70(5):846-7. DOI: 10.1302/0301-620X.70B5.3192599. View

14.

Kalamchi A . Monteggia fracture-dislocation in children. Late treatment in two cases. J Bone Joint Surg Am. 1986; 68(4):615-9. View

15.

Stoll T, Willis R, Paterson D . Treatment of the missed Monteggia fracture in the child. J Bone Joint Surg Br. 1992; 74(3):436-40. DOI: 10.1302/0301-620X.74B3.1587897. View

16.

Horii E, Nakamura R, Koh S, Inagaki H, Yajima H, Nakao E . Surgical treatment for chronic radial head dislocation. J Bone Joint Surg Am. 2002; 84(7):1183-8. DOI: 10.2106/00004623-200207000-00014. View

17.

BADO J . The Monteggia lesion. Clin Orthop Relat Res. 1967; 50:71-86. View

18.

Jensen V . Tardy posterior interosseous nerve palsy as a result of an unreduced radial head dislocation in Monteggia fractures: a report of two cases. J Hand Surg Am. 1984; 9(4):572-5. DOI: 10.1016/s0363-5023(84)80112-4. View

19.

Rodgers W, Waters P, Hall J . Chronic Monteggia lesions in children. Complications and results of reconstruction. J Bone Joint Surg Am. 1996; 78(9):1322-9. DOI: 10.2106/00004623-199609000-00005. View