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Four different management strategies in missed Monteggia lesions in children
Hüseyin Bilgehan Çevi K1, Fatih Yuvaci2, Engin Ecevi Z2
1University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of Orthopaedics and Traumatology, Sehit Omer Halisdemir St. Dışkapı 06110, Altındağ, Ankara, Turkey.
Insights
Surgical management of missed Monteggia lesions in 18 pediatric patients showed no major complications. All patients achieved painless range of motion, indicating surgery is preferable to conservative treatment for these challenging fractures.
Area of Science:
- Pediatric Orthopaedics
- Surgical Management
- Fracture Treatment
Background:
- Missed Monteggia lesions pose a clinical challenge for pediatric orthopaedic surgeons.
- Delayed diagnosis can lead to increased morbidities and complications.
Purpose of the Study:
- To evaluate surgical outcomes in 18 pediatric patients with missed Monteggia lesions diagnosed within 4 months of injury.
- To compare the effectiveness of different surgical strategies.
Main Methods:
- Retrospective review of 18 consecutive cases treated between 2011 and 2014.
- Analysis of preoperative and postoperative radiographs, Oxford Elbow Score, and bony architecture.
- Evaluation of radial head dislocation, ulnar pathology, and carrying angle.
Main Results:
- No major surgical complications were reported.
- All patients regained painless range of motion and achieved radiocapitellar joint reduction.
- Ligament reconstruction or transcapitellar k-wire fixation did not significantly impact outcomes.
Conclusions:
- Surgical management is recommended over conservative treatment due to high morbidity associated with missed Monteggia lesions.
- Addressing ulnar deformity is crucial for successful radiocapitellar joint reduction.
- The specific surgical strategy is less critical than achieving 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.
