A Novel Case of Neglected Monteggia Fracture Dislocation
Abstract
Background: The Monteggia fracture-dislocation is a rare condition among children, and its treatment is still controversial. The treatment can become quite complicated when the diagnosis is delayed. There is a broad range of surgical treatments with various complications like subluxations, degenerative changes, and radial head deformity. The present case was reported as a novel surgical treatment choice for neglected Monteggia fracture-dislocation.
Case Report: A 16 year-old boy presented with left elbow severe range of motion (ROM) limitation and pain who was diagnosed with neglected Monteggia fracture-dislocation. The patient went through open reduction beside internal fixation of the ulnar shaft via Limited Contact Dynamic Compression Plate (LC-DCP) and radio-capitellar joint reduction and provisional fixation by a pin. The patient recovered after three months with a significant increase in elbow ROM without any complications.
Conclusion: This method could be an appropriate treatment of choice for neglected Monteggia fractures which indeed had excellent outcomes without complication.
Soni JF, Valenza WR, Matsunaga CU, Costa ACP, Faria Chronic monteggia fracture-dislocation in children surgical strategy and results. Acta Ortop Bras. 2019;27(5):244-7. doi:
10.1590/1413-785220192705215273. [PubMed: 31839731]. [PubMed Central: PMC6901151].
Suarez R, Barquet A, Fresco Epidemiology and treatment of monteggia lesion in adults: series of 44 cases. Acta Ortop Bras. 2016;24(1):48-51. doi: 10.1590/1413-785220162401152249. [PubMed: 26997915]. [PubMed Central: PMC4775490].
Bado The Monteggia lesion. Clin Orthop Relat Res. 1967;50:71-86. [PubMed: 6029027].
Noonan KJ, Price Forearm and distal radius fractures in children. J Am Acad Orthop Surg. 1998;6(3):146-56. doi: 10.5435/00124635-199805000-00002. [PubMed: 9689186].
Kay RM, Skaggs DL. The pediatric Monteggia f Am J Orthop (Belle Mead NJ). 1998;27(9):606-9. [PubMed: 9758451].
Gleeson AP, Beattie Monteggia fracture-dislocation in children. J Accid Emerg Med. 1994;11(3):192-4. 10.1136/emj.11.3.192. [PubMed: 7804589]. [PubMed Central: PMC1342431].
Najd Mazhar F, Jafari D, Shariatzadeh H, Dehghani Nazhvani H, Taghavi Surgical outcome of neglected monteggia fracture- dislocation in pediatric patients: A case series. J Res Orthop. 2019;6(1):e85225. doi: 10.5812/soj.85225.
Goyal T, Arora SS, Banerjee S, Kandwal Neglected Monteggia fracture dislocations in children: A systematic review. J Pediatr Orthop B. 2015;24(3):191-9. doi: 10.1097/BPB.0000000000000147. [PubMed: 25714935].
Ramski DE, Hennrikus WP, Bae DS, Baldwin KD, Patel NM, Waters PM, et Pediatric monteggia fractures: A multicenter examination of treatment strategy and early clinical and radiographic results. J Pediatr Orthop. 2015;35(2):115-20. doi: 10.1097/BPO.0000000000000213. [PubMed: 24978320].
Bae Successful Strategies for Managing Monteggia Injuries. J Pediatr Orthop. 2016;36 (Suppl 1):S67-S70. doi: 10.1097/BPO.0000000000000765. [PubMed: 27100040].
Gyr BM, Stevens PM, Smith Chronic Monteggia fractures in children: Outcome after treatment with the Bell-Tawse procedure. J Pediatr Orthop B. 2004;13(6):402-6. doi: 10.1097/01202412-200411000-00011. [PubMed: 15599234].
Eygendaal D, Hillen Open reduction and corrective ulnar osteotomy for missed radial head dislocations in children. Strategies Trauma Limb Reconstr. 2007;2(1):31-4. doi: 10.1007/s11751-007-0013-9. [PubMed: 18427912]. [PubMed Central: PMC2321721].
Belangero WD, Livani B, Zogaib Treatment of chronic radial head dislocations in children. Int Orthop. 2007;31(2):151-4. doi: 10.1007/s00264-006-0153-4. [PubMed: 16741732]. [PubMed Central: PMC2267559].
Rahbek O, Deutch SR, Kold S, Sojbjerg JO, Moller-Madsen Long-term outcome after ulnar osteotomy for missed Monteggia fracture dislocation in children. J Child Orthop. 2011;5(6):449-57. doi: 10.1007/s11832-011-0372-0. [PubMed: 23205146]. [PubMed Central: PMC3221759].
Hasler CC, Von LL, Hell Open reduction, ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius. J Bone Joint Surg Br. 2005;87(1):88-94. [PubMed: 15686243].
Lu X, Kun WY, Zhang J, Zhu Z, Guo Y, Lu Management of missed Monteggia fractures with ulnar osteotomy, open reduction, and dual-socket external fixation. J Pediatr Orthop. 2013;33(4):398-402. doi: 10.1097/BPO.0b013e3182812762. [PubMed: 23653029].
Horii E, Nakamura R, Koh S, Inagaki H, Yajima H, Nakao Surgical treatment for chronic radial head dislocation. J Bone Joint Surg Am. 2002;84(7):1183-8. doi: 10.2106/00004623- 200207000-00014. [PubMed: 12107319].
Stoll TM, Willis RB, Paterson Treatment of the missed Monteggia fracture in the child. J Bone Joint Surg Br.
Stoll TM, Willis RB, Paterson Treatment of the missed Monteggia fracture in the child. J Bone Joint Surg Br.
1992;74(3):436-40. doi: 10.1302/0301-620X.74B3.1587897.
[PubMed: 1587897].
Tajima T, Yoshizu Treatment of long-standing dislocation of the radial head in neglected Monteggia fractures. J Hand Surg Am. 1995;20(3 Pt 2):S91-S94. doi: 10.1016/s0363-5023(95)80177-4. [PubMed: 7642957].
Degreef I, De SL. Missed radial head dislocations in children associated with ulnar deformation: treatment by open reduction and ulnar osteotomy. J Orthop Trauma. 2004;18(6):375- doi: 10.1097/00005131-200407000-00008. [PubMed: 15213503].
Ring D, Jupiter JB, Waters Monteggia fractures in children and adults. J Am Acad Orthop Surg. 1998;6(4):215-24. doi:
10.5435/00124635-199807000-00003. [PubMed: 9682084].
Tan JW, Mu MZ, Liao GJ, Li Pathology of the annular ligament in paediatric Monteggia fractures. Injury. 2008;39(4):451-5. doi: 10.1016/j.injury.2007.07.010. [PubMed: 18005963].
Koslowsky TC, Mader K, Wulke AP, Gausepohl T, Pennig Operative treatment of chronic Monteggia lesion in younger children: a report of three cases. J Shoulder Elbow Surg. 2006;15(1):119-21. doi: 10.1016/j.jse.2004.12.002. [PubMed: 16414480].
Di Gennaro GL, Martinelli A, Bettuzzi C, Antonioli D, Rotini Outcomes after surgical treatment of missed Monteggia fractures in children. Musculoskelet Surg. 2015;99(Suppl 1): S75-S82. doi: 10.1007/s12306-015-0362-3. [PubMed: 25957548].
10.1590/1413-785220192705215273. [PubMed: 31839731]. [PubMed Central: PMC6901151].
Suarez R, Barquet A, Fresco Epidemiology and treatment of monteggia lesion in adults: series of 44 cases. Acta Ortop Bras. 2016;24(1):48-51. doi: 10.1590/1413-785220162401152249. [PubMed: 26997915]. [PubMed Central: PMC4775490].
Bado The Monteggia lesion. Clin Orthop Relat Res. 1967;50:71-86. [PubMed: 6029027].
Noonan KJ, Price Forearm and distal radius fractures in children. J Am Acad Orthop Surg. 1998;6(3):146-56. doi: 10.5435/00124635-199805000-00002. [PubMed: 9689186].
Kay RM, Skaggs DL. The pediatric Monteggia f Am J Orthop (Belle Mead NJ). 1998;27(9):606-9. [PubMed: 9758451].
Gleeson AP, Beattie Monteggia fracture-dislocation in children. J Accid Emerg Med. 1994;11(3):192-4. 10.1136/emj.11.3.192. [PubMed: 7804589]. [PubMed Central: PMC1342431].
Najd Mazhar F, Jafari D, Shariatzadeh H, Dehghani Nazhvani H, Taghavi Surgical outcome of neglected monteggia fracture- dislocation in pediatric patients: A case series. J Res Orthop. 2019;6(1):e85225. doi: 10.5812/soj.85225.
Goyal T, Arora SS, Banerjee S, Kandwal Neglected Monteggia fracture dislocations in children: A systematic review. J Pediatr Orthop B. 2015;24(3):191-9. doi: 10.1097/BPB.0000000000000147. [PubMed: 25714935].
Ramski DE, Hennrikus WP, Bae DS, Baldwin KD, Patel NM, Waters PM, et Pediatric monteggia fractures: A multicenter examination of treatment strategy and early clinical and radiographic results. J Pediatr Orthop. 2015;35(2):115-20. doi: 10.1097/BPO.0000000000000213. [PubMed: 24978320].
Bae Successful Strategies for Managing Monteggia Injuries. J Pediatr Orthop. 2016;36 (Suppl 1):S67-S70. doi: 10.1097/BPO.0000000000000765. [PubMed: 27100040].
Gyr BM, Stevens PM, Smith Chronic Monteggia fractures in children: Outcome after treatment with the Bell-Tawse procedure. J Pediatr Orthop B. 2004;13(6):402-6. doi: 10.1097/01202412-200411000-00011. [PubMed: 15599234].
Eygendaal D, Hillen Open reduction and corrective ulnar osteotomy for missed radial head dislocations in children. Strategies Trauma Limb Reconstr. 2007;2(1):31-4. doi: 10.1007/s11751-007-0013-9. [PubMed: 18427912]. [PubMed Central: PMC2321721].
Belangero WD, Livani B, Zogaib Treatment of chronic radial head dislocations in children. Int Orthop. 2007;31(2):151-4. doi: 10.1007/s00264-006-0153-4. [PubMed: 16741732]. [PubMed Central: PMC2267559].
Rahbek O, Deutch SR, Kold S, Sojbjerg JO, Moller-Madsen Long-term outcome after ulnar osteotomy for missed Monteggia fracture dislocation in children. J Child Orthop. 2011;5(6):449-57. doi: 10.1007/s11832-011-0372-0. [PubMed: 23205146]. [PubMed Central: PMC3221759].
Hasler CC, Von LL, Hell Open reduction, ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius. J Bone Joint Surg Br. 2005;87(1):88-94. [PubMed: 15686243].
Lu X, Kun WY, Zhang J, Zhu Z, Guo Y, Lu Management of missed Monteggia fractures with ulnar osteotomy, open reduction, and dual-socket external fixation. J Pediatr Orthop. 2013;33(4):398-402. doi: 10.1097/BPO.0b013e3182812762. [PubMed: 23653029].
Horii E, Nakamura R, Koh S, Inagaki H, Yajima H, Nakao Surgical treatment for chronic radial head dislocation. J Bone Joint Surg Am. 2002;84(7):1183-8. doi: 10.2106/00004623- 200207000-00014. [PubMed: 12107319].
Stoll TM, Willis RB, Paterson Treatment of the missed Monteggia fracture in the child. J Bone Joint Surg Br.
Stoll TM, Willis RB, Paterson Treatment of the missed Monteggia fracture in the child. J Bone Joint Surg Br.
1992;74(3):436-40. doi: 10.1302/0301-620X.74B3.1587897.
[PubMed: 1587897].
Tajima T, Yoshizu Treatment of long-standing dislocation of the radial head in neglected Monteggia fractures. J Hand Surg Am. 1995;20(3 Pt 2):S91-S94. doi: 10.1016/s0363-5023(95)80177-4. [PubMed: 7642957].
Degreef I, De SL. Missed radial head dislocations in children associated with ulnar deformation: treatment by open reduction and ulnar osteotomy. J Orthop Trauma. 2004;18(6):375- doi: 10.1097/00005131-200407000-00008. [PubMed: 15213503].
Ring D, Jupiter JB, Waters Monteggia fractures in children and adults. J Am Acad Orthop Surg. 1998;6(4):215-24. doi:
10.5435/00124635-199807000-00003. [PubMed: 9682084].
Tan JW, Mu MZ, Liao GJ, Li Pathology of the annular ligament in paediatric Monteggia fractures. Injury. 2008;39(4):451-5. doi: 10.1016/j.injury.2007.07.010. [PubMed: 18005963].
Koslowsky TC, Mader K, Wulke AP, Gausepohl T, Pennig Operative treatment of chronic Monteggia lesion in younger children: a report of three cases. J Shoulder Elbow Surg. 2006;15(1):119-21. doi: 10.1016/j.jse.2004.12.002. [PubMed: 16414480].
Di Gennaro GL, Martinelli A, Bettuzzi C, Antonioli D, Rotini Outcomes after surgical treatment of missed Monteggia fractures in children. Musculoskelet Surg. 2015;99(Suppl 1): S75-S82. doi: 10.1007/s12306-015-0362-3. [PubMed: 25957548].
| Files | ||
| Issue | Vol 7, No 3 (2021) | |
| Section | Case Report | |
| DOI | https://doi.org/10.18502/jost.v7i3.8113 | |
| Keywords | ||
| Elbow Joint Dislocations Monteggia's Fracture | ||
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How to Cite
1.
Najafi A, Basiri P, Azarsina S, Mirhoseini MS, Seif E. A Novel Case of Neglected Monteggia Fracture Dislocation. J Orthop Spine Trauma. 2022;7(3):116-9.
