Monteggia lesions and equivalent lesions in children

Abstract

Missed Monteggia lesions results in chronic luxation and deficits in the range of motion. The overall therapeutic goal is aquick and stable anatomical repositioning of the lesion. The prognosis of Monteggia lesions in comparison to its equivalents is better, especially with early diagnosis. Comparison of the types of lesion, treatment modalities, hospitalization, immobilization, movement deficits, perioperative complications and outcome. Retrospective study of 62patients treated with acute Monteggia lesions and its equivalents during the period of 2009-2020. 2patients were treated with cast immobilization only, 11with repositioning under general anesthesia, 39with intramedullary nailing and 10with screw osteosynthesis. The average observation period was 4.1months. Patients with cast immobilization needed only ashort hospitalization (2days), patients with repositioning or osteosynthesis had longer hospitalization (3.4 or 4.3days, respectively). Deficits of the range of motion did not appear in simple cast immobilization or intramedullary nailing without reduction; however, patients with closed reduction or screw osteosynthesis showed some degree of deficits (9% and 40%, respectively). Monteggia lesions needed shorter hospitalization than their equivalents (3.7 vs. 4.5days) and had less deficits in the range of motion (7% vs. 21%). Most patients were treated with osteosynthesis (79%). Patients with Monteggia lesions had abetter outcome than patients with equivalent lesions.