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Missed Monteggia injuries.

Kenneth S David-West1, Neil I L Wilson, David A Sherlock

  • 1Department of Orthopaedic Surgery, The Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK. kd-west@ntlworld.com

Injury
|October 11, 2005
PubMed
Summary

Monteggia injuries, often missed in children, require prompt diagnosis. Early treatment via closed manipulation yields good results, while delayed cases necessitate surgical intervention for favorable outcomes.

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Area of Science:

  • Orthopedic Surgery
  • Pediatric Traumatology
  • Radiology

Background:

  • Monteggia injuries involve radial head dislocation, with or without ulnar fracture.
  • Variant Monteggia injuries may present with plastic deformation of the ulna instead of a fracture.
  • Missed diagnoses are common, particularly in variant types, leading to delayed treatment.

Purpose of the Study:

  • To review Monteggia injuries treated between 1992 and 2001.
  • To evaluate the impact of delayed diagnosis on treatment and outcomes.
  • To propose a diagnostic protocol for Monteggia injuries.

Main Methods:

  • Retrospective review of 39 Monteggia injuries.
  • Analysis of diagnostic intervals and treatment modalities.
  • Assessment of clinical and radiological outcomes.

Main Results:

  • Eight cases (20.5%) were missed, predominantly variant types.
  • Early diagnosis (within 4 weeks) allowed successful closed manipulation.
  • Late diagnoses required surgical intervention, including ulnar osteotomy and radial head stabilization.

Conclusions:

  • Prompt diagnosis and treatment of Monteggia injuries are crucial for optimal outcomes.
  • A high index of suspicion is needed for variant injuries.
  • Surgical management, including ulnar osteotomy and annular ligament repair, can achieve acceptable results in late-diagnosed cases.

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