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Pathology of the annular ligament in paediatric Monteggia fractures
1Department of Orthopaedic Surgery, Shandong University, Jinan, Shandong, China.
Insights
In pediatric Monteggia fractures, the annular ligament is often interposed in the radiohumeral joint. Surgical reduction of this ligament is recommended for optimal outcomes in children.
Area of Science:
- Pediatric Orthopedics
- Pediatric Trauma Surgery
- Pediatric Musculoskeletal Disorders
Background:
- Monteggia fractures are complex elbow injuries in children.
- The role of the annular ligament in these fractures requires clarification.
- Understanding annular ligament behavior is crucial for effective treatment.
Purpose of the Study:
- To detail operative findings of the annular ligament in pediatric Monteggia fractures.
- To propose evidence-based treatment recommendations for these injuries.
Main Methods:
- Operative treatment of 35 children with type I and III Monteggia fractures.
- Surgical exploration and reduction of the annular ligament.
- Ulnar fracture fixation using open reduction with wire/plate fixation or closed reduction with external fixation.
Main Results:
- Excellent functional outcomes at 6-month follow-up, including bone healing and elbow range of motion.
- No instances of radial head redislocation or subluxation.
- Absence of heterotopic ossification on follow-up radiographs.
Conclusions:
- Annular ligaments are intact but frequently interposed in pediatric Monteggia fractures.
- Transverse ruptures occur at the joint capsule's lower margin.
- Reduction of the annular ligament is recommended for pediatric Monteggia fractures.
Objectives:
To report our operative findings regarding the annular ligament in paediatric Monteggia fractures and to propose treatment recommendation for Monteggia fracture.
Patients And Methods:
A total of 35 children with type I and type III Monteggia fractures were treated operatively. The radial heads were all explored surgically in this series. The interposed ligament was stretched out of the joint space and was reduced around the radial head. In some of the patients, the joint capsule was repaired. Sixteen ulnar fractures were managed with open reduction and wire fixation, and 13 broken ulnas were fixed by plating. Six ulnar fractures were greenstick type and were treated by closed reduction and external fixation.
Results:
All the patients were functionally excellent at the 6-month follow-up in terms of bone healing and the range of motion of the elbow joint. No redislocation or subluxation of the radial head was found until in the last follow-up. No heterotropic ossification was observed in any follow-up radiographs.
Conclusions:
The annular ligaments were intact in all paediatric patients with type I and type III Monteggia fractures and the ruptures were transversely on the joint capsule at the lower margin of the ligament. Most of the annular ligaments were interposed in the radiohumeral joint even though the radiographs showed reduction of the radial heads. We recommend reduction of the annular ligament in paediatric patients with Monteggia fractures.
