Monteggia injuries and radial neck fractures in children

Abstract

This paper reviews the means to evaluate these injuries and reviews the evidence for different management strategies. Monteggia injuries and radial neck fractures are not amongst the most common fractures in children. However, the morbidity associated with a missed or underappreciated injury can be significant. Monteggia injuries are classically associated with a fracture of the ulna but radio-capitellar dislocation can also occur with plastic deformation of the ulna alone. Closed reduction of the ulna is the primary method of management. The reduction is stabilized by application of cast or fixation of the ulna; though uncertainty remains about how aggressive surgeons should be with ulnar fixation. Should a patient present late ulnar osteotomy is often required to allow reduction of the radio-capitellar joint. Radial neck fractures are often associated with other injuries around the elbow. The fracture can result in both angulation and translation. Angulation can be better tolerated and has a higher potential for remodelling. If translation of more than 2–3 mm is present this can result in the fracture healing with a significant cam lesion which impinges on rotation of the forearm. There are several means to try and achieve a closed reduction which are described.