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Radial head distalisation with an external ring fixator as a therapy option in children with chronic posttraumatic radiocapitellar dislocations

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Abstract

Purpose

Missed monteggia-type injuries in children can result in chronic radial head dislocation with anatomic changes and osteoarticular remodeling of the radial head. In later stages, joint reconstruction is impossible and a functional radial head distalization can be a therapy option in symptomatic patients.

Methods

From 2010 to 2018, 46 patients (18 female and 28 male, mean age 11.8 (4–20)) with chronic radius head dislocation treated in our institution were retrospectively analyzed. A radial head distalization was performed in symptomatic patients at the time of ulna lengthening and angulation by use of an external ring fixator. We analyzed the surgical and radiographic data as well as the clinical outcome of the patients measured by DASH and Mayo Elbow score.

Results

16 patients (6 female, 10 male) fulfilled the criteria for functional radial head distalization. Main reason was Monteggia injury in 11 cases, and radial head fracture in 5 cases. Average follow-up was 5.1 years (range 1–9, SD 2.1). Mean time from injury was 4.14 years (range: 4 months to 12 years, SD 3.5 years). Mean duration of external fixation was 106 days (range 56–182, SD 31.2), lengthening was 21.3 mm (range 12–42, SD 8.8). Average degree of sagittal angulation 14.8° (0–32°, SD 10.7°), coronal angulation 4.4° (0–25°, SD 7.3°). DASH score showed a good result with 2.4, and the MAYO Elbow Score was excellent (95/100). No secondary luxation of the radius head was detected.

Conclusion

Radial head distalization with external ring fixator can be a therapy option for chronic radius head dislocations in symptomatic patients without losing stability of the elbow joint in contrast to radial head resection.

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Availability of data and material

Data were obtained from the hospital servers with personal accounts.

Data sharing

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Slongo T, Fernandez FF. Incorrectly healed Monteggia lesion in childhood and adolescence. Unfallchirurg. 2011;114:311–22. https://doi.org/10.1007/s00113-011-1961-6.

    Article  CAS  PubMed  Google Scholar 

  2. Monteggia G. Istituzioni Chirurgiche. Milan: Maspero; 1814.

    Google Scholar 

  3. Bado JL. The Monteggia lesion. Clin Orthop Relat Res. 1967;50:71–86.

    Article  CAS  PubMed  Google Scholar 

  4. David-West KS, Wilson NI, Sherlock DA, et al. Missed Monteggia injuries. Injury. 2005;36:1206–9. https://doi.org/10.1016/j.injury.2004.12.033.

    Article  PubMed  Google Scholar 

  5. Hubbard J, Chauhan A, Fitzgerald R, et al. Missed pediatric Monteggia fractures. JBJS Rev. 2018;6: e2. https://doi.org/10.2106/jbjs.Rvw.17.00116.

    Article  PubMed  Google Scholar 

  6. Rahbek O, Deutch SR, Kold S, et al. Long-term outcome after ulnar osteotomy for missed Monteggia fracture dislocation in children. J Child Orthop. 2011;5:449–57. https://doi.org/10.1007/s11832-011-0372-0.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kim HT, Conjares JN, Suh JT, et al. Chronic radial head dislocation in children, part 1: pathologic changes preventing stable reduction and surgical correction. J Pediatr Orthop. 2002;22:583–90.

    Article  PubMed  Google Scholar 

  8. Gleeson AP, Beattie TF. Monteggia fracture-dislocation in children. J Accid Emerg Med. 1994;11:192–4. https://doi.org/10.1136/emj.11.3.192.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Fowles JV, Sliman N, Kassab MT. The Monteggia lesion in children. Fracture of the ulna and dislocation of the radial head. J Bone Jt Surg Am. 1983;65:1276–82.

    Article  CAS  Google Scholar 

  10. Lloyd-Roberts GC, Bucknill TM. Anterior dislocation of the radial head in children: aetiology, natural history and management. J Bone Jt Surg Br. 1977;59-b:402–7. https://doi.org/10.1302/0301-620x.59b4.925049.

    Article  CAS  Google Scholar 

  11. Garg R, Fung BK, Chow SP, et al. Surgical management of radial head dislocation in quadriplegic cerebral palsy: a 5 year follow-up. J Hand Surg Eur. 2007;32:725–6. https://doi.org/10.1016/j.Jhse.2007.05.001.

    Article  Google Scholar 

  12. Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med. 1983;11:315–9. https://doi.org/10.1177/036354658301100506.

    Article  CAS  PubMed  Google Scholar 

  13. Nakamura K, Hirachi K, Uchiyama S, et al. Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children. J Bone Jt Surg Am. 2009;91:1394–404. https://doi.org/10.2106/jbjs.H.00644.

    Article  Google Scholar 

  14. Holst-Nielsen F, 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;9:572–5. https://doi.org/10.1016/s0363-5023(84)80112-4.

    Article  CAS  PubMed  Google Scholar 

  15. Chen WS. Late neuropathy in chronic dislocation of the radial head. Report of two cases. Acta Orthop Scand. 1992;63:343–4. https://doi.org/10.3109/17453679209154798.

    Article  CAS  PubMed  Google Scholar 

  16. Seel MJ, Peterson HA. Management of chronic posttraumatic radial head dislocation in children. J Pediatr Orthop. 1999;19:306–12.

    Article  CAS  PubMed  Google Scholar 

  17. Kalamchi A. Monteggia fracture-dislocation in children. Late treatment in two cases. J Bone Jt Surg Am. 1986;68:615–9.

    Article  CAS  Google Scholar 

  18. Delpont M, Jouve JL, de Sales GJ, et al. Proximal ulnar osteotomy in the treatment of neglected childhood Monteggia lesion. Orthop Traumatol Surg Res. 2014;100:803–7. https://doi.org/10.1016/j.otsr.2014.06.022.

    Article  CAS  PubMed  Google Scholar 

  19. Koslowsky TC, Mader K, Wulke AP, et al. Operative treatment of chronic Monteggia lesion in younger children: a report of three cases. J Shoulder Elbow Surg. 2006;15:119–21. https://doi.org/10.1016/j.jse.2004.12.002.

    Article  CAS  PubMed  Google Scholar 

  20. Lädermann A, Ceroni D, Lefèvre Y, et al. Surgical treatment of missed Monteggia lesions in children. J Child Orthop. 2007;1:237–42. https://doi.org/10.1007/s11832-007-0039-z.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Stoll TM, Willis RB, Paterson DC. Treatment of the missed Monteggia fracture in the child. J Bone Jt Surg Br. 1992;74:436–40. https://doi.org/10.1302/0301-620x.74b3.1587897.

    Article  CAS  Google Scholar 

  22. Exner GU. Missed chronic anterior Monteggia lesion. Closed reduction by gradual lengthening and angulation of the ulna. J Bone Jt Surg Br. 2001;83:547–50. https://doi.org/10.1302/0301-620x.83b4.11103.

    Article  CAS  Google Scholar 

  23. Hasler CC, Von Laer L, Hell AK. Open reduction, ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius. J Bone Jt Surg Br. 2005;87:88–94.

    Article  CAS  Google Scholar 

  24. 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;18:375–8. https://doi.org/10.1097/00005131-200407000-00008.

    Article  CAS  PubMed  Google Scholar 

  25. Bor N, Rubin G, Rozen N, et al. Chronic anterior monteggia lesions in children: report of 4 cases treated with closed reduction by ulnar osteotomy and external fixation. J Pediatr Orthop. 2015;35:7–10. https://doi.org/10.1097/bpo.0000000000000203.

    Article  PubMed  Google Scholar 

  26. Bell Tawse AJ. The treatment of malunited anterior Monteggia fractures in children. J Bone Jt Surg Br. 1965;47:718–23.

    Article  CAS  Google Scholar 

  27. Dormans JP, Rang M. The problem of Monteggia fracture-dislocations in children. Orthop Clin N Am. 1990;21:251–6.

    Article  CAS  Google Scholar 

  28. Hurst LC, Dubrow EN. Surgical treatment of symptomatic chronic radial head dislocation: a neglected Monteggia fracture. J Pediatr Orthop. 1983;3:227–30. https://doi.org/10.1097/01241398-198305000-00015.

    Article  CAS  PubMed  Google Scholar 

  29. Letts M, Locht R, Wiens J. Monteggia fracture-dislocations in children. J Bone Jt Surg Br. 1985;67:724–7. https://doi.org/10.1302/0301-620x.67b5.4055869.

    Article  CAS  Google Scholar 

  30. Kim HT, Park BG, Suh JT, et al. Chronic radial head dislocation in children, Part 2: results of open treatment and factors affecting final outcome. J Pediatr Orthop. 2002;22:591–7.

    Article  PubMed  Google Scholar 

  31. Klug A, Konrad F, Gramlich Y, et al. Surgical treatment of the radial head is critical to the outcome of Monteggia-like lesions. Bone Jt J. 2019;101:1512–9. https://doi.org/10.1302/0301-620x.101b12.Bjj-2019-0547.R1.

    Article  Google Scholar 

  32. Oka K, Murase T, Moritomo H, et al. Morphologic evaluation of chronic radial head dislocation: three-dimensional and quantitative analyses. Clin Orthop Relat Res. 2010;468:2410–8. https://doi.org/10.1007/s11999-010-1283-y.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Best TN. Management of old unreduced Monteggia fracture dislocations of the elbow in children. J Pediatr Orthop. 1994;14:193–9. https://doi.org/10.1097/01241398-199403000-00012.

    Article  CAS  PubMed  Google Scholar 

  34. Gyr BM, Stevens PM, Smith JT. Chronic Monteggia fractures in children: outcome after treatment with the Bell-Tawse procedure. J Pediatr Orthop B. 2004;13:402–6. https://doi.org/10.1097/01202412-200411000-00011.

    Article  PubMed  Google Scholar 

  35. Hirayama T, Takemitsu Y, Yagihara K, et al. Operation for chronic dislocation of the radial head in children. Reduction by osteotomy of the ulna. J Bone Jt Surg Br. 1987;69:639–42. https://doi.org/10.1302/0301-620x.69b4.3611173.

    Article  CAS  Google Scholar 

  36. Storen G. Traumatic dislocation of the radial head as an isolated lesion in children; report of one case with special regard to roentgen diagnosis. Acta Chir Scand. 1959;116:144–7.

    CAS  PubMed  Google Scholar 

  37. Slongo TF. Korrekturosteotomie der fehlverheilten Monteggia-Verletzung mit einem Fixateur externe. Oper Orthop Traumatol. 2008;20:435–49. https://doi.org/10.1007/s00064-008-1414-8.

    Article  PubMed  Google Scholar 

  38. Hui JH, Sulaiman AR, Lee HC, et al. Open reduction and annular ligament reconstruction with fascia of the forearm in chronic monteggia lesions in children. J Pediatr Orthop. 2005;25:501–6. https://doi.org/10.1097/01.bpo.0000158812.37225.b3.

    Article  PubMed  Google Scholar 

  39. Inoue G, Shionoya K. Corrective ulnar osteotomy for malunited anterior Monteggia lesions in children. 12 patients followed for 1–12 years. Acta Orthop Scand. 1998;69:73–6. https://doi.org/10.3109/17453679809002361.

    Article  CAS  PubMed  Google Scholar 

  40. Song KS, Ramnani K, Bae KC, et al. Indirect reduction of the radial head in children with chronic Monteggia lesions. J Orthop Trauma. 2012;26:597–601. https://doi.org/10.1097/BOT.0b013e3182548981.

    Article  PubMed  Google Scholar 

  41. Lu X, Kun Wang Y, Zhang J, et al. Management of missed Monteggia fractures with ulnar osteotomy, open reduction, and dual-socket external fixation. J Pediatr Orthop. 2013;33:398–402. https://doi.org/10.1097/BPO.0b013e3182812762.

    Article  PubMed  Google Scholar 

  42. Captier G, Canovas F, Mercier N, et al. Biometry of the radial head: biomechanical implications in pronation and supination. Surg Radiol Anat. 2002;24:295–301. https://doi.org/10.1007/s00276-002-0059-9.

    Article  CAS  PubMed  Google Scholar 

  43. Tubbs RS, O’Neil JT Jr, Key CD, et al. The oblique cord of the forearm in man. Clin Anat. 2007;20:411–5. https://doi.org/10.1002/ca.20346.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors are grateful to all the patients who were included in the study.

Funding

There is no funding of this study.

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Authors and Affiliations

  1. Department of Orthopedics, Olga Hospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Germany

    O. Loose, M. Langendoerfer, O. Eberhardt, T. Wirth & F. F. Fernandez

  2. Department of Orthopedics, The Royal Children’s Hospital, Parkville, Australia

    S. G. Morrison

  3. Melbourne Medical School, The University of Melbourne, Parkville, Australia

    S. G. Morrison

  4. Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany

    O. Loose

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Correspondence to O. Loose.

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Ethical review statement

The study was approved by Ethics Committee of the Landesärztekammer Baden-Württemberg (F2021-091).

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Loose, O., Morrison, S.G., Langendoerfer, M. et al. Radial head distalisation with an external ring fixator as a therapy option in children with chronic posttraumatic radiocapitellar dislocations. Eur J Trauma Emerg Surg 49, 1803–1810 (2023). https://doi.org/10.1007/s00068-022-02173-w

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