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Outcomes after surgical treatment of missed Monteggia fractures in children

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Abstract

Background

Chronic dislocation of the radial head treatment in Monteggia fracture dislocation is still controversial. We present a large series of patients treated in our Institution.

Materials and methods

The outcome of 22 children treated surgically between 1988 and 2011 for post-traumatic chronic radial head dislocation is reported. There were 12 girls and 10 boys with a mean age at surgery of 7.2 years (4.1–13.6). The mean interval between injury and treatment was 15.7 months (1–128). Nine patients underwent open reduction with removal of interposed tissue and repair (7) or Bell-Tawse reconstruction (2) of the annular ligament. Ten patients underwent osteotomy, gradual lengthening and angulation of the ulna by external fixation. Two patients underwent angular osteotomy of the proximal ulna with open wedge, open reduction in the radial head and reconstruction of the annular ligament. One patient admitted to the hospital 10 years after injury underwent radial head excision at 13.7 years of age.

Results

After a mean follow-up of 5.5 years (1–24.3), the radial head stayed reduced in 15 patients and subluxated in 5. In one case, redislocation occurred. All patients but five were pain-free. The elbow performance score (Kim score) was excellent in 14 cases, good in four and fair in four, with a mean score of 91, corresponding to a good result. Complications included a transient posterior interosseus nerve palsy (1), and one non-union of the ulna.

Discussion and conclusion

Chronic Monteggia lesions must be treated. The clinical outcomes are usually better than the congruency of the radiocapitellar joint.

Level of evidence

IV (Case series with no comparison group).

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Conflict of interest

The authors declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Pediatric Orthopaedic and Trauma Division, Istituto Ortopedico Rizzoli, Bologna, Italy

    Giovanni L. Di Gennaro, Alessandro Martinelli, Camilla Bettuzzi & Diego Antonioli

  2. Shoulder and Elbow Surgery Unit, Istituto Ortopedico Rizzoli, Bologna, Italy

    Roberto Rotini

Authors
  1. Giovanni L. Di Gennaro
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  2. Alessandro Martinelli
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  3. Camilla Bettuzzi
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  4. Diego Antonioli
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  5. Roberto Rotini
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Corresponding authors

Correspondence to Giovanni L. Di Gennaro or Alessandro Martinelli.

Additional information

Ethical Committee approved no. 18779.

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Di Gennaro, G.L., Martinelli, A., Bettuzzi, C. et al. Outcomes after surgical treatment of missed Monteggia fractures in children. Musculoskelet Surg 99 (Suppl 1), 75–82 (2015). https://doi.org/10.1007/s12306-015-0362-3

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  • DOI: https://doi.org/10.1007/s12306-015-0362-3

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