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Missed Monteggia fracture dislocation in children
1Department of Orthopaedics, School of Medical Sciences, University Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
Injury
|March 1, 1997
Summary
For pediatric Monteggia fractures presenting late, open radial head reduction without annular ligament repair yielded excellent outcomes. This effective treatment for children avoids ligament reconstruction, simplifying care.
Area of Science:
- Pediatric Orthopedics
- Pediatric Trauma Surgery
- Pediatric Bone Healing
Background:
- Monteggia fracture dislocations in children, especially those presenting late (>1 month post-injury), pose treatment challenges.
- Traditional management often involves open reduction of the radial head and annular ligament reconstruction.
- This study explores an alternative approach for specific types of Monteggia lesions.
Observation:
- Three pediatric patients (ages 2-6) with anterior Monteggia fracture dislocations were treated.
- The delay between injury and surgical intervention ranged from 6 to 8 weeks.
- Treatment involved open reduction of the radial head, stabilized with a Kirschner wire, omitting annular ligament repair.
Findings:
- All three patients achieved pain-free outcomes with no visible deformity.
- Post-operative follow-up (1-5 years) showed no radial head subluxation.
- Elbows demonstrated nearly full flexion, with full forearm supination but restricted pronation.
Implications:
- Open reduction of the radial head, stabilized with Kirschner wires, may be a viable alternative to annular ligament reconstruction in select pediatric Monteggia fractures.
- This technique simplifies surgical management for late-presenting Monteggia injuries in children.
- Further research could validate this approach and define optimal patient selection criteria.