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International Orthopaedics

, Volume 38, Issue 12, pp 2519–2524 | Cite as

“Sliding angulation osteotomy”: preliminary report of a novel technique of treatment for chronic radial head dislocation following missed Monteggia injuries

  • Shanmuganathan RajasekaranEmail author
  • Krishnamoorthy Venkatadass
Original Paper

Abstract

Purpose

Neglected anterior radial head dislocation in type I Monteggia lesions leads to restriction of movement, deformity and instability of the affected elbow. If left untreated this leads to a painful arthritic elbow due to secondary degenerative changes. This is a difficult problem to manage and many intra-articular, extra-articular and combined procedures have been described with variable results. We report a new technique of sliding angulation osteotomy for this condition, which allows both lengthening and angulation of the ulna.

Methods

A novel technique of sliding angulation osteotomy of the proximal ulna was done to achieve reduction of the radial head. Four patients with persistent anterior radial head dislocation were treated at our institution with this technique.

Results

All of them had good clinical and radiological outcomes at final follow-up.

Conclusions

Sliding angulation osteotomy is a technically simple procedure, which achieves lengthening and angulation of the ulna simultaneously in the sagittal plane and reduces the radial head.

Keywords

Monteggia lesion Missed Dislocation Radial head Ulnar osteotomy 

Supplementary material

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References

  1. 1.
    Ring D, Jupiter JB, Waters PM (1998) Monteggia fractures in children and adults. J Am Acad Orthop Surg 6:215–224PubMedGoogle Scholar
  2. 2.
    Bado J (1967) The Monteggia lesion. Clin Orthop 50:71–86PubMedGoogle Scholar
  3. 3.
    Korner J, Hansen M, Weinberg A, Hessmann M, Rommens PM (2004) Monteggia fractures in childhood–diagnosis and management in acute and chronic cases. Current concepts and review of the literature. Eur J Trauma 30:361–370CrossRefGoogle Scholar
  4. 4.
    Boyd HB, Boals JC (1969) The Monteggia lesion. A review of 159 cases. Clin Orthop 66:94–100PubMedGoogle Scholar
  5. 5.
    Lädermann A, Ceroni D, Lefèvre Y, De Rosa V, De Coulon G, Kaelin A (2007) Surgical treatment of missed Monteggia lesions in children. J Child Orthop 1:237–242PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Bell Tawse AJ (1965) The treatment of malunited anterior Monteggia fractures in children. J Bone Joint Surg Br 47:718–723PubMedGoogle Scholar
  7. 7.
    Lloyd-Roberts GC, Bucknill TM (1977) Anterior dislocation of the radial head in children. aetiology, natural history and management. J Bone Joint Surg Br 59-B(4):402–407PubMedGoogle Scholar
  8. 8.
    Gyr BM, Stevens PM, Smith JT (2004) Chronic Monteggia fractures in children: outcome after treatment with the Bell-Tawse procedure. J Pediatr Orthop B 13:402–406PubMedCrossRefGoogle Scholar
  9. 9.
    Oner FC, Diepstraten AF (1993) Treatment of chronic post-traumatic dislocation of the radial head in children. J Bone Joint Surg Br 75:577–581PubMedGoogle Scholar
  10. 10.
    Devnani AS (1997) Missed Monteggia fracture dislocation in children. Injury 28:131–133PubMedCrossRefGoogle Scholar
  11. 11.
    Hirayama T, Takemitsu Y, Yagihara K, Mikita A (1987) Operation for chronic dislocation of the radial head in children. Reduction by osteotomy of the ulna. J Bone Joint Surg Br 69:639–642PubMedGoogle Scholar
  12. 12.
    Freedman L, Luk K, Leong JC (1988) Radial head reduction after a missed Monteggia fracture: brief report. J Bone Joint Surg Br 70:846–847PubMedGoogle Scholar
  13. 13.
    Stoll TM, Willis RB, Paterson DC (1992) Treatment of the missed Monteggia fracture in the child. J Bone Joint Surg Br 74:436–440PubMedGoogle Scholar
  14. 14.
    Best TN (1994) Management of old unreduced Monteggia fracture dislocations of the elbow in children. J Pediatr Orthop 14:193–199PubMedCrossRefGoogle Scholar
  15. 15.
    Kemnitz S, De Schrijver F, De Smet L (2000) Radial head dislocation with plastic deformation of the ulna in children. A rare and frequently missed condition. Acta Orthop Belg 66(4):359–362PubMedGoogle Scholar
  16. 16.
    Horii E, Nakamura R, Koh S et al (2002) Surgical treatment for chronic radial head dislocation. J Bone Joint Surg Am 84-A:1183–1188PubMedGoogle Scholar
  17. 17.
    Degreef I, De Smet L (2004) Missed radial head dislocations in children associated with ulnar deformation: treatment by open reduction and ulnar osteotomy. J Orthop Trauma 18:375–378PubMedCrossRefGoogle Scholar
  18. 18.
    David-West KS, Wilson NI, Sherlock DA, Bennet GC (2005) Missed Monteggia injuries. Injury 36(10):1206–1209PubMedCrossRefGoogle Scholar
  19. 19.
    Wang MN, Chang WN (2006) Chronic posttraumatic anterior dislocation of the radial head in children: thirteen cases treated by open reduction, ulnar osteotomy, and annular ligament reconstruction through a Boyd incision. J Orthop Trauma 20(1):1–5PubMedCrossRefGoogle Scholar
  20. 20.
    Eygendaal D, Hillen RJ (2007) Open reduction and corrective ulnar osteotomy for missed radial head dislocations in children. Strategies Trauma Limb Reconstr 2:31–34PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Exner GU (2001) Missed chronic anterior Monteggia lesion. Closed reduction by gradual lengthening and angulation of the ulna. J Bone Joint Surg Br 83:547–550PubMedCrossRefGoogle Scholar
  22. 22.
    Hasler CC, Von Laer L, Hell AK (2005) Open reduction, ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius. J Bone Joint Surg Br 87:88–94PubMedGoogle Scholar
  23. 23.
    Gicquel P, De Billy B, Karger C, Maximin MC, Clavert JM (2000) Treatment of neglected Monteggia’s fracture by ulnar lengthening using the Ilizarov technique. Rev Chir Orthop Reparatrice Appar Mot 86:844–847PubMedGoogle Scholar
  24. 24.
    Belangero WD, Livani B, Zogaib RK (2007) Treatment of chronic radial head dislocations in children. Int Orthop 31(2):151–154PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Mehta SD (1985) Flexion osteotomy of ulna for untreated Monteggia fracture in children. Ind J Surg 47:15–19Google Scholar
  26. 26.
    Kim HT, Park BG, Suh JT, Yoo IC (2002) Chronic radial head dislocation in children, part 2: results of open treatment and factors affecting final outcome. J Pediatr Orthop 22:591–597PubMedGoogle Scholar
  27. 27.
    Kim HT, Conjares JNV, Suh JT, Yoo IC (2002) Chronic head dislocation in Children, part 1: pathologic changes preventing stable reduction and surgical correction. J Pediatr Orthop 22:583–590PubMedGoogle Scholar
  28. 28.
    Rodgers WB, Waters PM, Hall JE (1996) Chronic Monteggia lesions in children. Complications and results of reconstruction. J Bone Joint Surg Am 78:1322–1329PubMedGoogle Scholar

Copyright information

© SICOT aisbl 2014

Authors and Affiliations

  • Shanmuganathan Rajasekaran
    • 1
    Email author
  • Krishnamoorthy Venkatadass
    • 1
  1. 1.Department of Orthopaedics & Spine SurgeryGanga HospitalCoimbatoreIndia

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