Abstract
IntroductionA Monteggia facture dislocation is not an uncommon injury, and the diagnosis can often be missed. Long-term follow-up of untreated Monteggia fracture dislocations reveals development of premature arthritis, pain, instability, and loss of pronation and supination. Methods involving annular ligament reconstruction require post-operative immobilization and use of transcapitellar pinning for maintenance of reduction, and thus a delay in rehabilitation. The literature reports satisfactory results with methods that involve ulnar osteotomy and open reduction of the radial head without annular ligament reconstruction. We used the Ilizarov method in two cases with neglected Monteggia fracture dislocations to stably reduce the radial head without open reduction and annular ligament reconstruction.Case presentationWe report two cases of neglected Monteggia fracture dislocation, in two Kashmiri boys aged four and six years. Using ulnar osteotomy with distraction osteogenesis, we were able to relocate the radial head gradually and maintain the reduction without a requirement for open reduction and annular ligament reconstruction.ConclusionDistraction lengthening and hyperangulation in different planes by use of the Ilizarov technique effectively reduces the radial head without open reduction and annular ligament reconstruction.
Highlights
A Monteggia facture dislocation is not an uncommon injury, and the diagnosis can often be missed
Distraction lengthening and hyperangulation in different planes by use of the Ilizarov technique effectively reduces the radial head without open reduction and annular ligament reconstruction
An underlying ulnar injury in both our cases was suspected because of the loss of proximal convexity of ulna (Figure 1).We chose a procedure that would produce controlled lengthening and hyperangulation in two planes to restore the radiocapitellar articulation without open reduction and reconstruction of annular ligament
Summary
Giovanni Battista Monteggia first described in 1814 the fracture dislocation named after him. An underlying ulnar injury in both our cases was suspected because of the loss of proximal convexity of ulna (Figure 1).We chose a procedure (the Ilizarov technique) that would produce controlled lengthening and hyperangulation in two planes to restore the radiocapitellar articulation without open reduction and reconstruction of annular ligament. Because the dislocation in both of our patients was an anterolateral one (Figures 1, 2), an osteotomy in the proximal ulna and differential lengthening in two planes was planned to create a medial (Figure 3) and posterior (Figure 4) hyperangulation, to place the radial head in the appropriate radiocapitellar orientation. Relocation took longer for our second patient, being achieved by the fifth postoperative week and involving lengthening of the ulna by 15 mm (Figure 6) Both patients were encouraged to perform range of motion exercises of the elbow, and the frame was left in place until maturation of the regenerated bone. The ring was taken off at six weeks for our first patient and at 12 weeks for our second patient; for both, a protective long arm cast was applied
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