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[Treatment of Monteggia fracture in children]
Insights
This study presents a therapeutic strategy for pediatric Monteggia fractures based on 72 cases. Treatment decisions for pediatric ulnar fractures and radial head dislocations depend on age and injury specifics.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Skeletal Development
Background:
- Monteggia fractures are complex pediatric injuries involving the ulna and radial head.
- Effective management is crucial to prevent long-term complications such as growth disturbances and joint instability.
- Previous treatment strategies varied, necessitating a refined approach based on empirical data.
Purpose of the Study:
- To establish a therapeutic concept for managing Monteggia fractures in children.
- To correlate treatment outcomes with patient age, fracture characteristics, and associated injuries.
- To define criteria for surgical intervention and fixation methods.
Main Methods:
- Retrospective group study of 72 pediatric Monteggia fracture cases.
- Evaluation of therapeutic approaches based on age, ulnar fracture type, radial head reducibility, and concurrent injuries.
- Analysis of surgical stabilization techniques, including closed reduction, open reduction with internal fixation, and external immobilization.
Main Results:
- The necessity for surgical ulnar fracture stabilization increases with the child's age.
- High-stability anatomic reduction of the ulna is essential for stable radial head fixation.
- Closed reduction sufficed in many cases; open reduction and internal fixation were required for irreducible/unstable ulnar fractures or irreducible radial heads.
Conclusions:
- A tailored therapeutic approach for pediatric Monteggia fractures is proposed, considering age and injury complexity.
- Minimal osteosynthesis with a cast is suitable for younger children, while plate fixation is preferred for older children.
- Radial head stabilization can be achieved through various methods, including Kirschner wires or ligament reconstruction.
Abstract:
Described in this paper is a therapeutic concept by which to cope with Monteggia's fracture in childhood. It is based on experience obtained from 72 cases with injuries of that kind and their evaluation in a group study. Therapeutic approach to the individual case was determined by the following criteria: age of infant, localisation and shape of ulnar fracture, reducibility of capitulum radii, and accompanying injuries requiring treatment on the same arm. The need for surgical stabilisation of ulnar fracture was found to increase along with growing age of the affected child. High-stability anatomic reduction of the ulnar fracture proved to be a prerequisite for safe stabilisation of the radial capitulum. Close reduction has proved to be sufficient in many instances. Open reduction and internal fixation were found to be necessary in cases in which an ulnar fracture was irreducible or instable and/or a radial head was not reducible. Minimal osteosynthesis and plaster cast is considered to be an optional therapy for younger children, whereas ulnar stabilisation by means of plates is preferred for children in somewhat advanced age of childhood. The radial head may be fixed by trans-articular Kirschner's wire (WITT) or primary reconstruction of the annular ligament, using a strip of biceps or triceps tendon, or adaptation around the collum radii and ulna of the proximal radio-ulnar joint by means of a sling of Dexon or Vicryl suture.