Monteggia Lesion Research Articles

Open Reduction and Annular Ligament Reconstruction With Fascia of the Forearm in Chronic Monteggia Lesions in Children

Fifteen children with chronic Monteggia lesions were treated with open reduction, annular ligament reconstruction with fascia of the forearm, and ulnar osteotomy. Mean age was 8 years 3 months (range 3-16 years). The chronicity of missed Monteggia was from 6 weeks to 2 years (mean 12 weeks). All patients were classified as Bado type I, except one with Bado type III. Mean follow-up was 4 years 3 months after surgery. There was a loss of pronation in six cases with the mean of 16 degrees. However, only four cases had rotational loss; the others had a mean rotational arch increase of 5 degrees. The flexion arches improved in all patients, with a mean of 27.7 degrees. The functional result was excellent in 11 patients, good in 3 patients, and poor in 1 patient. This one-incision approach is safe in treating chronic Monteggia lesions in children.

Delayed onset of adult Monteggia lesion

Delayed onset of adult Monteggia lesion

Kombinationsverletzungen des Unterarms - Monteggia-, Galeazzi- und Essex-Lopresti-Läsion

Monteggia, Galeazzi and Essex-Lopresti lesions are rarely combined injuries of the forearm. The injury pattern includes a fracture of either bone of the forearm with a dislocation either of the proximal or distal radioulnar joint. Mistakes in the diagnosis of these fracture - dislocations account for a high incidence of unsatisfactory results. Monteggia and Galeazzi lesions are best treated with open reduction and internal stabilization of the fracture and closed reduction of the dislocated proximal or distal radioulnar joint. They need an early functional aftertreatment to achieve good results. Essex-Lopresti lesions should be managed by an interfragmentary fixation or prosthetic replacement of the radial head and an immobilisation in forearm-supination for 2 weeks.

Monteggia Fractures in Childhood?Diagnosis and Management in Acute and Chronic Cases

Monteggia fractures are rare injuries. Early recognition is crucial in order to achieve good functional results. In the presented review paper it is pointed out that any fracture or angulation of the ulna should thoroughly be checked for any incomplete or complete dislocation of the radial head. Adequate clinical examination and radiologic evaluation are mandatory. The aim of treatment must be repositioning and retention of the radial head and restoration of the ulnar alignment. During the last years, surgical treatment has become more important for achieving good functional results and foar avoiding secondary corrective surgery. For the majority of acute Monteggia lesions, immediate repositioning maneuvers with surgical stabilization of the ulna (elastic nailing techniques) under general anesthesia are indicated. Cast immobilization is of short duration; physical therapy is normally not necessary. Treatment of missed Monteggia lesions or chronic radial head dislocations is more difficult. Nevertheless, newer surgical techniques for secondary operative correction of ulnar malalignment are promising.

Posterior interosseous nerve injury complicating ulnar osteotomy for a missed Monteggia fracture

We describe a 6-year-old boy with a posterior interosseous nerve injury after an ulnar osteotomy for a chronic Monteggia lesion. Although the first consultant did an ulnar osteotomy to reduce the radial head, the posterior interosseous nerve palsy did not recover. Next we found that the posterior interosseous nerve had been drawn into the radiocapitellar joint. It is important to confirm interposition of the nerve at the radiocapitellar joint during corrective osteotomy for a chronic Monteggia lesion.

Atrophic nonunions of the proximal ulna.

Ten consecutive patients were treated by one surgeon for an atrophic nonunion of the proximal ulna. There were six men and four women with an average age of 47 years. Nine of the initial injuries were fracture-dislocations (seven posterior Monteggia lesions and two transolecranon fracture-dislocations) and one was a fracture of the proximal ulnar and radial diaphysis. The nonunion was associated with failed operative fixation in nine patients and occurred after treatment in cast in one patient. Three patients had synovial pseudarthroses and eight had bony defects. Debridement of the nonunion, autogenous cancellous bone grafting, and contoured limited-contact plate fixation were done at an average of 36 months after the original injury. The patients were followed up for an average of 39 months. Union was achieved in all 10 patients. The average arc of ulnohumeral motion was 105 degrees and the average arc of forearm rotation was 130 degrees. According to the system of Broberg and Morrey five patients had an excellent result, four had a good result, and one had a fair result. The fair result was attributable to proximal radioulnar synostosis and severe ulnohumeral arthrosis. Atrophic nonunion of fractures of the proximal ulna usually follow a complex injury treated with inadequate fixation. Stable plate fixation and autogenous bone graft predictably lead to union, but the functional result may be limited by associated problems.

Ipsilateral Supracondylar Humerus Fracture and Monteggia Lesion: A Case Report

Two to 13% of supracondylar humerus fractures in children are associated with an ipsilateral forearm fracture, most of which are distal radius fractures. We present an unusual case of a 2-year-old girl with an ipsilateral supracondylar humerus fracture and a Monteggia lesion. Our management consisted of percutaneous K-wire fixation of the supracondylar humerus fracture and percutaneous insertion of an intramedullary K-wire for stabilization of the ulna fracture. Our patient had an excellent result, and we would recommend this method of fixation for similar injuries.

A rare case of Monteggia's lesion in children

The authors present a rare case of a Monteggia lesion in a child. The fracture of the proximal ulnar metaphysis is associated with a dislocation of the radial head. The outcome is good after closed reduction and six weeks cast. Two years later, the function is normal.

Missed chronic anterior Monteggia lesion

Two consecutive cases of chronic dislocation of the head of the radius after missed Bado type-I Monteggia lesions are presented. Reduction was successfully achieved in both patients after ulnar corticotomy, gradual lengthening and angulation of the ulna using an external fixator. Open reduction or reconstruction of the radio-ulnar capitellar joint was not undertaken. The age at injury was seven years in the older and two years in the younger patient. The time from injury to treatment was five years in the older and three months in the younger child. At follow-up, nine years after completion of treatment in the older and eight months in the younger patient, both show satisfactory movement, function of the forearm and reduction of the head of the radius. This technique may be considered in missed Monteggia lesions before open procedures on the radio-ulnar capitellar joint are undertaken.

TREATMENT OF ULNAR FRACTURE WITH DISLOCA TION OF CA PUT RADII (MONTEGGIA LESION) IN 2 DOGS AND 3 CATS

Two dOKS and three cats with Monteggia lesions were diaKnosed due to clinicaL and radiological examinations which were subjected in this study.Type I, type ii and type III MontegE;ia lesions were diagnosed in two dogs and three cats. Reduction and ./ıxation o{ ulnar ./i"aetures were perl'ormed under general anesthesia usinK Steinman pin in one dog, intramedu!lar Kirschner wires in three cats and DCP in one dOE;.The reduction o{ the radicı! head was maintained by .\vnthetie substitution o{ the annular ligament in one case by trans/ixatio/1 ol' ulna ~ith a sereı'v i/1O/1ecase and with semi cerclaKe in three cases. Coaptatio/1 bcll7- daKes were used post operatively for three week.\'. It is observed that ('(Ises beKwı to use their leKs pmperly between 60 and 90 days post operatively. Complications such as incomplete ca!lus formation. recurrent subluxatiO/1 ol' radial head, periarticular ossi/ication. osteoarthritis. poor function o{ art. eubiti and synostosis between radius and ulna were not developed. As a conc/usion. this study presents detailed knowledge on MonteKgicl lesions, in which there are limited studies on this subject

Result of Surgical Treatment of Old Monteggia Lesions in Children

Result of Surgical Treatment of Old Monteggia Lesions in Children

Monteggia fractures in children and adults.

The eponymous term "Monteggia fracture" is most precisely used to refer to dislocation of the proximal radioulnar joint in association with a forearm fracture. It is the character of the ulnar fracture, rather than the direction of radial head dislocation, that is useful in determining the optimal treatment of Monteggia fractures in both children and adults. Stable anatomic reduction of the ulnar fracture results in anatomic reduction of the radial head. The notoriously poor results of treatment of Monteggia fractures in adults improved dramatically after the development of modern techniques of plate-and-screw fixation, which facilitate early mobilization by ensuring anatomic reduction. The relatively good results associated with nonoperative treatment of pediatric Monteggia injuries reflect the prevalence of stable (incomplete) fractures in children. Unstable (complete) ulnar fractures are prone to residual or recurrent displacement and may require operative fixation. Late reconstruction of chronic Monteggia lesions in children can be complicated and unpredictable. The key to a good outcome after a Monteggia-type fracture-dislocation of the forearm remains early recognition of proximal radioulnar dissociation.

Transolecranon Fracture-Dislocation of the Elbow

To characterize the prevalence, morphology, and prognosis of anterior (transolecranon) fracture-dislocations of the elbow. Retrospective case series. A consecutive series of thirteen patients from a single level-one trauma center, plus four patients from the practices of two of the senior authors. Three of seventeen patients had simple, oblique fractures of the olecranon, and fourteen had complex, comminuted fractures of the proximal ulna, including fragmentation of the olecranon in seven patients, large coronoid fragments in eight patients, and segmental fractures of the ulna in six patients. Fourteen patients were male and three were female, with an average age of thirty-eight years (range, 18 to 78 years). All fractures were treated by open reduction and internal fixation. Two one-third tubular plates had to be revised to 3.5-millimeter dynamic compression plates within six weeks of the initial operation. Elbow performance rating of Broberg and Morrey. At an average follow-up of twenty-five months, overall outcome was rated as excellent in seven patients, good in eight, and fair in two. Mild posttraumatic arthritis was noted in only two patients. Large coronoid fragments and extensive comminution of the trochlear notch did not preclude a good result provided that stable, anatomic fixation was achieved. Anterior elbow dislocations occur most often as a fracture-dislocation in which the distal humerus is driven through the olecranon, thereby causing a complex, comminuted fracture of the proximal ulna. This injury is frequently confused with anterior Monteggia lesions by virtue of the readily apparent radiocapitellar dislocation. Stable restoration of the appropriate contour and dimensions of the trochlear notch of the ulna will lead to a good result in most cases.

Monteggia and equivalent lesions. A study of 41 cases.

Forty-one patients who suffered from a Monteggia fracture and were treated between 1984 and 1993 were reviewed retrospectively using a new motion score of the elbow joint. There were 14 children and 27 adults of whom 34 were available for review. The results in children were significantly better than those of the adults. Among the adults, the final results of the patients who had a Bado Type 1 equivalent injury were significantly worse than those of the other groups, especially when associated with a fracture of the radial head. The type of fracture, open or closed, the presence of a fracture of the olecranon, and the energy level of the trauma did not have any significant prognostic value. Good correlation was shown between the new motion score and the Figgie elbow score. The Bado Type 1 equivalent injuries should be considered as a special subgroup of the Monteggia lesion, necessitating extra attention in treatment and rehabilitation, and a close followup of the patient.

MONTEGGIA LESION IN A CHILD: VARIANT OF A BADO TYPE-IV LESION. A CASE REPORT

Monteggia described a lesion that consisted of a fracture of the proximal third of the ulna and an anterior dislocation of the proximal end of the radius1. Bado, in a series of forty patients, found that the fracture and dislocation could be displaced in various directions; he modified the original definition of a Monteggia lesion to “a group of traumatic lesions having in common a dislocation of the radio-humero-ulnar joint, associated with a fracture of the ulna at various levels or with lesions at the wrist.”2 This is a case report of a four-year-old boy who sustained a Monteggia fracture-dislocation that was Bado2 type IV. The child had a posterolateral angulation deformity of the fracture of the ulna, posterolateral dislocation of the radial head, and a fracture of the middle third of the radial shaft. A four-year-old boy fell from a height of about ten feet (three meters) and sustained an injury of the right forearm. He had a severe posterolateral angular deformity in the proximal part of the forearm without any neurovascular deficit. Motion of the elbow and wrist was very painful and restricted. Roentgenograms showed a fracture of the proximal third of the ulna, with 55 degrees of lateral angulation on the anteroposterior roentgenogram and 30 degrees of posterior angulation on the lateral roentgenogram. The radial head was displaced posterolaterally, and there was a fracture through the middle third of the radial shaft (Fig. 1). In addition, at the site of the fracture, there was plastic deformation of the ulna in an anteromedial direction. Roentgenograms showing a Bado2 type-IV Monteggia lesion with posterolateral angulation of the ulna and posterolateral dislocation of the radial head. Two attempts at closed reduction with the patient under general anesthesia were unsuccessful. The angular deformity of the ulna …

CHRONIC MONTEGGIA LESIONS IN CHILDREN. COMPLICATIONS AND RESULTS OF RECONSTRUCTION

We retrospectively reviewed the results of operative treatment of chronic Monteggia lesions (Bado type I or the equivalent) with anterior radiocapitellar dislocation in seven patients. The mean age at the time of the reconstruction was six years and nine months (range, eleven months to twelve years), and the mean time from the injury to the operation was twelve months (range, five weeks to thirty-nine months). The mean duration of follow-up was four years and six months (range, two years to eleven years and three months). There were fourteen complications, including malunion of the ulnar shaft in one patient; residual radiocapitellar subluxation in two patients (one anterior and one posterolateral); radiocapitellar dislocation (dynamic anterior subluxation of the radial head in supination) in one patient; transient ulnar-nerve palsy in three patients (with residual weakness in two); partial laceration of the radial nerve in one patient; loss of the fixation in two patients; and non-union of the ulnar osteotomy site, compartment syndrome, conversion reaction, and possible fibrous synostosis of the forearm in one patient each. The patients lost a mean of 36 degrees of pronation and a mean of 27 degrees of supination of the forearm compared with the contralateral, uninjured extremity. Two patients demonstrated a loss of flexion of the elbow of 8 and 13 degrees and three had a loss of extension (mean, 15 degrees) compared with the contralateral side. There were three good, two fair, and two poor results.

Missed Monteggia fracture dislocation in children

Open reduction of the radial head and reconstruction of the annular ligament has been advocated for the Monteggia fracture dislocation in children who present more than a month after injury. Three patients with an anterior Monteggia lesion were treated by open reduction of the radial head which was held in place by a Kirschner wire passed from the humerus to the radius. No attempt was made either to repair or reconstruct the annular ligament. The patients were aged between 2 and 6 years, the delay between injury and reduction was between 6 and 8 weeks, and the length of follow up was 5 years for two patients and 1 year for the third. All three patients were free of pain, had no deformity and the radial head had not subluxated. All had nearly full flexion at the elbow. The forearm had full supination but restricted pronation.

Monteggia Lesion in a Child

BHANDARI, NAGESH M.S.(ORTH)†; JINDAL, PANKAJ M.S.(ORTH)‡, AHMEDABAD, INDIA Author Information

Treatment of long-standing dislocation of the radial head in neglected monteggia fractures

Long-standing dislocation of the radial head can result from a neglected Monteggia fracture or a congenital anomaly? Remodeling of the ulnar fracture site in Monteggia lesions can obscure the differential diagnosis from congenital dislocations of the radial head. Stability of the elbow joint depends on the congruity of the ulnohumeral joint and the ulnar collateral ligament. In the wrist joint, stability depends on the congruity of the radiocarpal joint and the palmar radiocarpal ligaments. The radiohumeral joint would thus appear to be less important than the ulnohumeral joint. However, in the extended elbow, 60% of the longitudinal forces are transmitted through the radiohumeral joint due to the carrying angle 2 (Fig. 1). Therefore, reduction of the radial head, either following a Monteggia fracture or in congenital cases, is considered very important.

肘頭骨折を合併した上腕骨外か骨折の１例

We report a case of injury to the lateral humeral condyle associated with fracture of the olecranon. It was suggested that the mechanism of injury was a varus strain and an indirect force along the forearm on the extended elbow and supinated forearm caused by a fall onto the outstrectched hand. This injury may be included as the equivalent of the Monteggia lesion.