Luxación anterior aislada e irreductible de la cúpula radial en un paciente pediátrico: un raro reporte de caso / Isolated irreducible anterior radial head dislocation in a child: a rare case report

La luxación de la cabeza radial suele asociarse a fractura o deformidad plástica cubital. La luxación aislada es rara. Sin tratamiento, puede evolucionar hacia deformidad cubital en valgo, lesión nerviosa, artrosis precoz y pérdida del rango de movilidad con limitación funcional. Se presenta a un paciente de 9 años que sufrió traumatismo de codo. Acudió a nuestra Institución a los 40 días y se diagnosticó luxación irreductible de la cabeza radial, primero desapercibida. La luxación era irreductible por un ojal en el ligamento anular y requirió ser reducida a cielo abierto. En ausencia de fractura, incluso sin evidencia de deformidad plástica del cúbito, debe sospecharse la luxación de la cabeza radial. La clínica, junto con el par radiográfico bilateral y el conocimiento de esta entidad poco frecuente, son el trípode necesario para alcanzar el diagnóstico y no demorar el tratamiento.

Anterior radial head dislocation in pediatric population is related to Monteggia fracture-dislocations. Isolated radial head dislocation is uncommon. Sometimes, radial head dislocation becomes irreducible. This entity can develop into chronic conditions such as nerve injuries, early osteoarthritis, limited range of motion and cubitus valgus. We describe a case of a 9-year-old patient who suffered elbow trauma. He was admitted to our institution 40 days after, where radial head dislocation was diagnosed. This condition was misdiagnosed at first stage. It was irreducible due to a tear in the annular ligament. He underwent open reduction. Radial head dislocation must be suspected even if there are no fractures or plastic deformity. Pure irreducible radial head dislocation is rare. Physical examination, together with plain bilateral radiographs and full acknowledgement of this rare condition are the basis to reach early diagnosis, which leads to proper non-delayed treatment.

[Isolated irreducible anterior radial head dislocation in a child: a rare case report]. / Luxación anterior aislada e irreductible de la cúpula radial en un paciente pediátrico: un raro reporte de caso.

Anterior radial head dislocation in pediatric population is related to Monteggia fracture-dislocations. Isolated radial head dislocation is uncommon. Sometimes, radial head dislocation becomes irreducible. This entity can develop into chronic conditions such as nerve injuries, early osteoarthritis, limited range of motion and cubitus valgus. We describe a case of a 9-year-old patient who suffered elbow trauma. He was admitted to our institution 40 days after, where radial head dislocation was diagnosed. This condition was misdiagnosed at first stage. It was irreducible due to a tear in the annular ligament. He underwent open reduction. Radial head dislocation must be suspected even if there are no fractures or plastic deformity. Pure irreducible radial head dislocation is rare. Physical examination, together with plain bilateral radiographs and full acknowledgement of this rare condition are the basis to reach early diagnosis, which leads to proper non-delayed treatment.

La luxación de la cabeza radial suele asociarse a fractura o deformidad plástica cubital. La luxación aislada es rara. Sin tratamiento, puede evolucionar hacia deformidad cubital en valgo, lesión nerviosa, artrosis precoz y pérdida del rango de movilidad con limitación funcional. Se presenta a un paciente de 9 años que sufrió traumatismo de codo. Acudió a nuestra Institución a los 40 días y se diagnosticó luxación irreductible de la cabeza radial, primero desapercibida. La luxación era irreductible por un ojal en el ligamento anular y requirió ser reducida a cielo abierto. En ausencia de fractura, incluso sin evidencia de deformidad plástica del cúbito, debe sospecharse la luxación de la cabeza radial. La clínica, junto con el par radiográfico bilateral y el conocimiento de esta entidad poco frecuente, son el trípode necesario para alcanzar el diagnóstico y no demorar el tratamiento.

Type III Monteggia fracture with posterior interosseous nerve injury in a child: A case report.

RATIONALE: Elbow injury in children by improper treatment or a delay of more than 3 weeks could lead to old unreduced Monteggia fracture, which are difficult to manage. Conservative or normal surgical methods usually fail. PATIENT CONCERNS: Herein, we present a 6-year-old boy with sustaining injury approximately 1 month to his left elbow. Activity in his elbow was restricted, and his ability to extend his wrist and fingers was impaired. DIAGNOSES: Type III Monteggia elbow fracture-dislocation consisting of radial head dislocation and malunion of the ulna associated with posterior interosseous nerve palsy were confirmed, which requiring surgical treatment. INTERVENTIONS: A closed reduction was performed with hyperplastic scar tissues erased and the radial head relocated. OUTCOMES: Follow-up 4 months later showed satisfactory recovery of function. LESSONS: Forearm fractures in children may be misjudged, and that early anatomical reduction rather than conservative treatment may be required.

Bilateral Monteggia fracture in adults.

INTRODUCTION: In 1814 Giovanni Monteggia first described two cases of fractures of the proximal third of ulna with dislocation of the radial head. These fractures are more common in children than in adults, and mutual Monteggia fracture is a rare complication. This study presents a treatment course of a patient with bilateral Monteggia fracture. CASE REPORT: A 55-year-old patient was injured by falling in the yard. Radiography showed bilateral Monteggia fracture type II (by the Badon classification). Operative treatment of fracture was done by a compression plate on the right side and by the zuggurtung technique on the left one. Closed repositioning of the radial head was done on both sides. The patient was wearing a plaster splint for the upper arm for 21 days. After removing the fixation, the function of the elbow was determined by the Broberg Morrey score (BM) which was on the right side 45.5 and on the left side 47.5. After the proper physical therapy, four months after the surgery, BM score was 100 on the right side, and 93 on the left one. CONCLUSION: Surgical treatment and early rehabilitation is the key for the return of good function of both elbows.

[Proximal ulna fractures]. / Proximale Ulnafrakturen.

Proximal ulna fractures are common injuries in the upper extremity. The severity of injury ranges from isolated olecranon fractures to complex elbow fracture dislocations. Relevant anatomic features of the proximal ulna for fracture management are presented in the first part of this article. Furthermore, standard and recent techniques of surgical treatment are described in detail for olecranon and Monteggia fractures as well as for fractures of the coronoid process. Functional outcome and complications of fracture treatment are discussed.

Type-IV variant Monteggia fracture with concurrent proximal radial physeal fracture in a Domestic Shorthaired Cat.

A fracture of the proximal 1/3 of the ulna, with concurrent fractures of the proximal radial physis and the distal 1/3 of the diaphysis of the radius occurred in a three-month-old, male, neutered, Domestic Shorthaired cat. The ulnar fracture was stabilised with an intramedullary pin. The proximal radial physeal fracture was reduced and stabilised with two crossed Kirschner wires. The proximal radius was secured to the ulna with an additional Kirschner wire. The distal radial diaphyseal fracture was stabilised with a five-hole, 2.0 mm dynamic compression plate (DCP). Six weeks postoperatively the cat was using the limb comfortably and demonstrated a full range of motion of the elbow joint. There were radiographic signs of fracture union and the radioulnar pin had migrated. The Kirschner wires were removed. Follow-up at 18 months postoperatively revealed that the cat was using the limb normally without any lameness. A full, pain-free range of motion was present in the joints of the left thoracic limb.

The influence of lateral and anterior angulation of the proximal ulna on the treatment of a Monteggia fracture: an anatomical cadaver study.

We have investigated the anatomy of the proximal part of the ulna to assess its influence on the use of plates in the management of fractures at this site. We examined 54 specimens from cadavers. The mean varus angulation in the proximal third was 17.5 degrees (11 degrees to 23 degrees ) and the mean anterior deviation 4.5 degrees (1 degrees to 14 degrees ). These variations must be considered when applying plates to the dorsal surface of the ulna for Monteggia-type fractures. A pre-operative radiograph of the contralateral elbow may also be of value.

Monteggia fractures and variants: review of distribution and nine irreducible radial head dislocations.

One hundred and twenty one cases of Monteggia fractures (68) and Monteggia fracture equivalent variant transolecranon fracture dislocations (53) in adults were reviewed to determine the frequency of Bado types and the occurrences of irreducible radial head dislocations. The distribution of Monteggia fractures was 53 Bado type I, two Bado type II, eight Bado type III, and five Bado type IV. Nine (13%) irreducible radial head dislocations were encountered (8 in Bado type I fractures and one in Bado type IV), including an unreported occurrence of biceps tendon interposition. The distribution in the Monteggia variants was 35 Bado type I, 14 Bado type II, one Bado type III, and two Bado type IV, without any irreducible radial heads. The present study demonstrates a greater preponderance of Bado type I than any other type among adult Monteggia fractures.

Monteggia fractures in adults. Review of 54 cases.

INTRODUCTION: We present a review of Monteggia fractures treated in our hospital between 1992 and 1998. PATIENTS AND METHODS: Fifty four patients with a Monteggia fracture were treated in our hospital with an average follow-up of 24 months (12-48 months). The average age was 41 years (18-81 years). According to the classification of Bado, there were 24 type I, 20 type II, 6 type III and 4 type IV. The etiology was in 27 cases a motor-vehicle and motorcycle accident, five a pedestrian struck by a car, 21 by a causal fall and only one by a direct hit by an iron bar in an assault. In 56% of the patients, the lesions were associated with polytrauma. In all the cases, treatment consisted of open reduction and internal fixation of the ulnar fracture using different methods of osteosynthesis (3.5 mm DCP, 3.5 mm reconstruction plates, 6.5 mm cancellous screw, tension band technique with Kirschner wires, and one-third tubular plates). Initial treatment of the radial head dislocation was attempted by closed reduction and verification under fluoroscopy. Subsequent open reduction and osteosynthesis were performed in 10 cases, and resection of radial head was necessary in three cases as the initial treatment. There were six open fractures with one case developing chronic infection. RESULTS: Results were evaluated according to the criteria of Anderson (union fracture, elbow and wrist flexion/extension). The results were excellent in nine patients (17%), satisfactory in 33 (61%), unsatisfactory in nine (17%) and failure in three (5%). Complications could be attributed to the severity of injury, type of fixation and errors in technique (four non-union, three failure of one-third tubular plates, one distal radioulnar instability) and to some features peculiar to this lesion (five nerve injuries, three redislocations of the radial head and four radioulnar synostosis). We needed to perform 14 reoperations to resolve some of the above mentioned complications.

Chronic radial head dislocation in children, Part 1: pathologic changes preventing stable reduction and surgical correction.

The pathologic changes in 15 elbows of 14 children (2 bilateral congenital, 12 unilateral posttraumatic, mean age 9.5 years) with radial head dislocation unreduced for at least 3 months (range 3-180 months) and their open treatment were reviewed. Common dysplastic changes observed in both congenital and posttraumatic groups included large deformed radial heads, slender radial necks, and ulnar bowing. Changes were bilateral and symmetrical in the congenital group. In traumatic dislocations, patients with more severe deformities had longer delays from time of injury to time of reduction. Persistent pain, limitation of motion, and deformity were unacceptable symptoms to both patients and their parents, prompting surgical intervention. To produce a smooth rotational arc for the radius and maintain it in stable reduction, restoration of the congruency of the capitello-radioulnar joint and correction of the various dysplastic changes were mandatory during open reduction.

The posterior Monteggia: a pathological lesion?

Ulnar fracture with posterior dislocation of the radial head is thought to be a relatively rare injury. We have recently treated six patients with this posterior Monteggia fracture dislocation. Five of these patients were on long-term corticosteroid therapy. The pathophysiology, treatment and outcome of this complex injury are discussed.

[Reflexion on thirty eight cases of Monteggia fracture of children (author's transl)]. / Réflexion à propos d'une série de 38 fractures de Monteggia chez l'enfant.

The authors report thirty eight cases of Monteggia fractures, seven of which being old dislocations of the head of the radius. They insist on early diagnosis and treatment of recent fractures, with a successful result if the ulnar hache become rightly alined. In late untreated luxations of the head of the radius, they occasionally use fascia lata transplant to repair the annular ligament, after correction of ulnar hache. However, early diagnosis and immediate full treatment are the best for successful result.