Changhoon Jeong; In Park

doi:10.12671/jkfs.2012.25.3.233

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Treatment of Neglected Monteggia Fracture in Children: Changhoon Jeong, M.D., In Park, M.D.; Journal of the Korean Fracture Society 2012;25(3):233-239.
DOI: https://doi.org/10.12671/jkfs.2012.25.3.233
Published online: July 16, 2012

Department of Orthopedic Surgery, The Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Korea.

Address reprint requests to: Changhoon Jeong, M.D. Department of Orthopedic Surgery, The Catholic University of Korea Bucheon St. Mary's Hospital, Sosa-ro 327, Wonmi-gu, Bucheon 420-717, Korea. Tel: 82-32-340-7089, Fax: 82-32-340-2671, changhoonj@naver.com

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REFERENCES

REFERENCES

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6. Degreef I, De Smet L. Missed radial head dislocations in children associated with ulnar deformation: treatment by open reduction and ulnar osteotomy. J Orthop Trauma, 2004;18:375-378.
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8. Evans EM. Pronation injuries of the forearm, with special reference to the anterior Monteggia fracture. J Bone Joint Surg Br, 1949;31B:578-588.
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10. Futami T, Tsukamoto Y, Fujita T. Rotation osteotomy for dislocation of the radial head. 6 cases followed for 7 (3~10) years. Acta Orthop Scand, 1992;63:455-456.
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12. 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;69:639-642.
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19. Letts M, Locht R, Wiens J. Monteggia fracture-dislocations in children. J Bone Joint Surg Br, 1985;67:724-727.
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Fig. 1

Classification of pediatric Monteggia fracture-dislocations. Redrawn from the article of Letts M, Locht R, Weins J19).

(A) Anterior plastic deformity (bending).

(B) Anterior greenstick fracture.

(C) Anterior complete fracture.

(D) Posterior.

(E) Lateral.

Fig. 2

Drawings of transverse cuts of proximal right radius and ulna (viewed distally) at the level of the radial head. Redrawn from the article of Seel MJ, Peterson HA (Fig. 1)26).

(A) Route of triceps tendon in Bell Tawse reconstruction. Direction of stability is posterior (large arrow).

(B) Drill hole placed obliquely to exit ulna at site of medial annular ligament attachment. Direction of stability is posteromedial (large arrow).

(C) Two drill holes exit the ulna at sites of medial and lateral annular ligament attachments. Direction of stability is anatomic (arrow).

Fig. 3

Revised from the article of Hirayama T, Takemitsu Y, Yagihara K, Mikita A (Fig. 1, 2)12). (A) Ulnar bending elongation osteotomy, (B) ulnar valgus elongation osteotomy.

Fig. 4

Pre-operative paper tracing for ulnar bending elongation osteotomy (modified Hirayama osteotomy). Point a: Anterior portion of the spherical surface of the capitellum. Point b: Center of the radial head. Redrawn from the article of Nakamura T, Yabe Y, Horiuchi Y (Fig. 1A, B, C)23).

(A) A seven-hole plate was applied to the dorsal cortex of the ulna. The most proximal screw was positioned at the level of the coronoid process. The osteotomy line was in the center of the plate.

(B) Both the distal part of the ulna (gray) and the radius (gray) were mobilized to localize point b opposite point a. The distance between point a and point b was at 0.5 to 1.0 mm to avoid excessive pressure on the radiohumeral joint after radial head reduction.

(C) The osteotomized ulna was fixed with a plate.

Fig. 5

A 5-year-old boy reported that he had fallen from a bar 6 months earlier. At the time of the injury, the fracture had been treated nonsurgically, and the dislocation had been missed. Approximately six months after the injury, open reduction with ulnar corrective osteotomy, anular ligament repair, and transcapitellar pin fixation was performed.

(A) Pre-operative radiographs of the elbow.

(B) Operative radiograph.

(C) Post-operative radiograph.

Figure & Data

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Surgical Timing of Treating Pediatric Trauma: Urgencies/Emergencies
Chang-Wug Oh, Joon-Woo Kim, Jong-Chul Lee
Journal of the Korean Fracture Society.2015; 28(2): 146. CrossRef

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Treatment of Neglected Monteggia Fracture in Children

J Korean Fract Soc. 2012;25(3):233-239. Published online July 31, 2012

DOI: https://doi.org/10.12671/jkfs.2012.25.3.233

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Fig. 1 Classification of pediatric Monteggia fracture-dislocations. Redrawn from the article of Letts M, Locht R, Weins J19). (A) Anterior plastic deformity (bending). (B) Anterior greenstick fracture. (C) Anterior complete fracture. (D) Posterior. (E) Lateral.

Fig. 2 Drawings of transverse cuts of proximal right radius and ulna (viewed distally) at the level of the radial head. Redrawn from the article of Seel MJ, Peterson HA (Fig. 1)26). (A) Route of triceps tendon in Bell Tawse reconstruction. Direction of stability is posterior (large arrow). (B) Drill hole placed obliquely to exit ulna at site of medial annular ligament attachment. Direction of stability is posteromedial (large arrow). (C) Two drill holes exit the ulna at sites of medial and lateral annular ligament attachments. Direction of stability is anatomic (arrow).

Fig. 3 Revised from the article of Hirayama T, Takemitsu Y, Yagihara K, Mikita A (Fig. 1, 2)12). (A) Ulnar bending elongation osteotomy, (B) ulnar valgus elongation osteotomy.

Fig. 4 Pre-operative paper tracing for ulnar bending elongation osteotomy (modified Hirayama osteotomy). Point a: Anterior portion of the spherical surface of the capitellum. Point b: Center of the radial head. Redrawn from the article of Nakamura T, Yabe Y, Horiuchi Y (Fig. 1A, B, C)23). (A) A seven-hole plate was applied to the dorsal cortex of the ulna. The most proximal screw was positioned at the level of the coronoid process. The osteotomy line was in the center of the plate. (B) Both the distal part of the ulna (gray) and the radius (gray) were mobilized to localize point b opposite point a. The distance between point a and point b was at 0.5 to 1.0 mm to avoid excessive pressure on the radiohumeral joint after radial head reduction. (C) The osteotomized ulna was fixed with a plate.

Fig. 5 A 5-year-old boy reported that he had fallen from a bar 6 months earlier. At the time of the injury, the fracture had been treated nonsurgically, and the dislocation had been missed. Approximately six months after the injury, open reduction with ulnar corrective osteotomy, anular ligament repair, and transcapitellar pin fixation was performed. (A) Pre-operative radiographs of the elbow. (B) Operative radiograph. (C) Post-operative radiograph.