Hüseyin Bilgehan Çevi K1, Fatih Yuvaci2, Engin Ecevi Z2, Güven Bulut2. 1. University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of Orthopaedics and Traumatology, Sehit Omer Halisdemir St. Dışkapı 06110, Altındağ, Ankara, Turkey. 2. University of Health Sciences, Kartal Dr. Lütfi Kırdar Research and Training Hospital, Department of Orthopaedics and Traumatology, Denizer St. Cevizli 34806, Kartal, İstanbul, Turkey.
Abstract
OBJECTIVES: Management of missed Monteggia lesions presents a challenging clinical scenario for pediatric orthopaedic surgeons as the patient may be exposed to possible morbidities and increased complications. There are several evidenced surgical strategies described. We aimed to present 18 patients diagnosed within 4 months of injury who were treated using 4 of the identified many surgical strategies. METHODS: Eighteen consecutive cases of missed Monteggia lesions were treated in our institution between 2011 and 2014. The mean delay from injury to surgery was 8.3 weeks (range 4-16). Bilateral preoperative and postoperative radiographs, Oxford Elbow Score, the direction of radial head dislocation, Bado classification, ulnar pathology (plastic deformation or fracture), carrying angle, head-neck ratio, any abnormal bony architecture, and any related condition. RESULTS: There were no major complications to surgery. All patients had regained painless range of motion of the forearm and elbow, and reduced radiocapitellar joint. Ligament reconstruction or transcapitellar k-wire fixation did not influence the radiographic or clinical outcome. CONCLUSIONS: Because conservative treatment of this injury may cause high morbidity, surgical management should be preferred in the foreground. The ulnar deformity is a key point in the reduction of the radiocapitellar joint. The preferred treatment strategy has no significant effect on the results as long as it provides radial head reduction.
OBJECTIVES: Management of missed Monteggia lesions presents a challenging clinical scenario for pediatric orthopaedic surgeons as the patient may be exposed to possible morbidities and increased complications. There are several evidenced surgical strategies described. We aimed to present 18 patients diagnosed within 4 months of injury who were treated using 4 of the identified many surgical strategies. METHODS: Eighteen consecutive cases of missed Monteggia lesions were treated in our institution between 2011 and 2014. The mean delay from injury to surgery was 8.3 weeks (range 4-16). Bilateral preoperative and postoperative radiographs, Oxford Elbow Score, the direction of radial head dislocation, Bado classification, ulnar pathology (plastic deformation or fracture), carrying angle, head-neck ratio, any abnormal bony architecture, and any related condition. RESULTS: There were no major complications to surgery. All patients had regained painless range of motion of the forearm and elbow, and reduced radiocapitellar joint. Ligament reconstruction or transcapitellar k-wire fixation did not influence the radiographic or clinical outcome. CONCLUSIONS: Because conservative treatment of this injury may cause high morbidity, surgical management should be preferred in the foreground. The ulnar deformity is a key point in the reduction of the radiocapitellar joint. The preferred treatment strategy has no significant effect on the results as long as it provides radial head reduction.
Authors: J M Bouyala; G Bollini; M Jacquemier; P Chrestian; J M Tallet; P Tisserand; A Mouttet Journal: Rev Chir Orthop Reparatrice Appar Mot Date: 1988
Authors: Jill Dawson; Helen Doll; Irene Boller; Ray Fitzpatrick; Christopher Little; Jonathan Rees; Andrew Carr Journal: Qual Life Res Date: 2008-10-29 Impact factor: 4.147