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[Monteggia injuries in childhood]
P Angermann1, M Lutz, R Zimmermann
1Universitäts-Klinik für Unfallchirurgie Innsbruck.
Handchirurgie, Mikrochirurgie, Plastische Chirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Handchirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Mikrochirurgie Der Peripheren Nerven Und Gefasse : Organ Der V
|October 19, 2000
Summary
Monteggia and equivalent injuries in children can achieve good functional results with proper fracture reduction. Surgical intervention may be necessary if conservative treatment fails to achieve adequate alignment.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Monteggia fracture-dislocation is a rare forearm injury involving ulnar fracture and radial head dislocation.
- Understanding treatment and long-term effects on bone growth is crucial for pediatric patients.
Purpose of the Study:
- To clarify therapeutic concepts for Monteggia and equivalent injuries in children.
- To evaluate the influence of these injuries on forearm bone growth.
- To present long-term clinical and radiological outcomes.
Main Methods:
- Retrospective study of 27 pediatric patients (ages 3-13) treated between 1977 and 1996.
- Analysis of clinical and radiological long-term results in 20 patients (2-21 years post-injury).
- Categorization into Group I (classic Monteggia) and Group II (Monteggia-equivalent injuries).
Main Results:
- Group I: 10/12 patients had no pain or loss of motion; one had pronation loss, one had persistent radial head dislocation.
- Group II: All surgically treated, showing more loss of elbow motion, forearm rotation, and elbow joint axis dislocation.
- Primary radial nerve palsy had a good prognosis; secondary median nerve paresthesia occurred in one case.
Conclusions:
- Good functional results are achievable for pediatric Monteggia and equivalent injuries with correct reduction.
- Surgical treatment (open reduction and internal fixation) is indicated when conservative methods fail.
- Accurate reduction of both ulnar fracture and radial head dislocation is key to optimal outcomes.