Impact of Open Reduction on Surgical Strategies for Missed Monteggia Fracture in Children.
10.3349/ymj.2017.58.4.829
- Author:
Hoon PARK
1
;
Kwang Won PARK
;
Kun Bo PARK
;
Hyun Woo KIM
;
Nam Kyu EOM
;
Dong Hoon LEE
Author Information
1. Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Missed Monteggia fracture;
open reduction;
ulnar osteotomy;
ulnar bow
- MeSH:
Child*;
Congenital Abnormalities;
Elbow;
Follow-Up Studies;
Head;
Humans;
Joints;
Ligaments;
Monteggia's Fracture*;
Osteotomy;
Retrospective Studies;
Ulna
- From:Yonsei Medical Journal
2017;58(4):829-836
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The aims of this study were to review our cases of missed Monteggia fracture treated by open reduction of the radial head with or without ulnar osteotomy and to investigate the indications for open reduction alone in surgical treatment of missed Monteggia fracture. MATERIALS AND METHODS: We retrospectively reviewed 22 patients who presented with missed Monteggia fracture. The patients' mean age at the time of surgery was 7.6 years. The mean interval from injury to surgery was 16.1 months. The surgical procedure consisted of open reduction of the radiocapitellar joint followed by ulnar osteotomy without reconstruction of the annular ligament. The mean period of follow-up was 3.8 years. Radiographic assessment was performed for the maximum ulnar bow (MUB) and the location of the MUB. Clinical results were evaluated with the Mayo Elbow Performance Index and Kim's scores. RESULTS: Five patients underwent open reduction alone, and 17 patients underwent open reduction and ulnar osteotomy. When the MUB was less than 4 mm and the location of the MUB was in the distal 40% of the ulna, we could achieve reduction of the radial head without ulnar osteotomy. The radial head was maintained in a completely reduced position in 21 patients and was dislocated in one patient at final follow-up. CONCLUSION: Open reduction alone can be an attractive surgical option in select patients with missed Monteggia fracture with minimal bowing of the distal ulna. However, ulnar osteotomy should be considered in patients with a definite ulnar deformity.
