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      Neglected Monteggia fracture: a review

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          Abstract

          • Monteggia fracture is characterized by radial head dislocation combined with proximal ulnar fracture.

          • If not diagnosed at an early stage, these lesions can gradually lead to forearm deformities and dysfunction, finally resulting in neglected Monteggia fracture. When the radial head is not reduced, several deformities develop at the humeroradial joint, including cubitus valgus and osteoarthritis.

          • Adequate radiographs are crucial when the surgeons deal with forearm injuries.

          • At present, proximal ulnar osteotomy and open reduction of chronic radial head dislocation provides satisfactory functional outcomes because of anatomic alignment reconstruction.

          • Supplementary procedures, including transcapitellar pinning and repair or reconstruction of the annular ligament, which are performed in order to enhance stability of the humeroradial joint, should be thoroughly assessed based on joint rotational stability after reduction and on potential complications.

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          Most cited references77

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          The Monteggia lesion.

          J Bado (2015)
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            Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children.

            There have been few reports on the long-term outcomes after the operative treatment of missed Monteggia fracture-dislocations in children. The purpose of the present study was to evaluate the long-term clinical and radiographic outcomes after open reduction for the treatment of a missed Monteggia fracture-dislocation. We postoperatively investigated the clinical and radiographic outcomes for twenty-two children with a missed Monteggia fracture. The study group included fourteen boys and eight girls who had had a mean age of ten years (range, four years to fifteen years and eleven months) at the time of open reduction. Each patient had been managed with open reduction of the radial head combined with a posterior bending elongation ulnar osteotomy and anular ligament reconstruction. Clinical and radiographic outcomes were reviewed over a mean duration of follow-up of seven years. The postoperative Mayo Elbow Performance Index at the time of follow-up ranged from 65 to 100, with nineteen excellent, two good, one fair, and no poor results. The radial head remained in a completely reduced position in seventeen patients and was subluxated in five patients at the time of the latest follow-up. In four patients, osteoarthritic changes were observed at the radiohumeral joint. Radiographically, there were fifteen good, seven fair, and no poor results. A good radiographic result was obtained in all of the patients who had undergone open reduction within three years after the injury or before the age of twelve years, whereas a fair result was obtained in seven of the remaining eight patients. If open reduction for the treatment of a missed Monteggia fracture is performed when the patient is less than twelve years of age or within three years after the injury, good long-term clinical and radiographic outcomes can be expected.
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              Monteggia fracture-dislocations in children.

              Thirty-three Monteggia fracture-dislocations occurring in patients aged 2 to 15 years were reviewed. A follow-up of 2 to 7 years in 25 patients revealed that 88% had good to excellent results and 12% had results which were fair or poor. Closed reduction was successful in 24 of 28 cases and appeared to be very effective. Open reduction was required only for older children or when treatment was begun late. A mild hyperextension deformity at the elbow noted on follow-up of patients with anterior dislocation of the radial head seemed to support the theory that the injury is caused by hyperextension. A new classification of Monteggia fracture-dislocations in children is proposed.
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                Author and article information

                Journal
                EFORT Open Rev
                EFORT Open Rev
                eor
                EFORT Open Reviews
                Bioscientifica Ltd (Bristol )
                2058-5241
                21 April 2022
                01 April 2022
                : 7
                : 4
                : 287-294
                Affiliations
                [1 ]Department of Orthopedics , Shanghai Jiao Tong University affiliated Sixth People’s Hospital, Shanghai, China
                [2 ]Department of Pediatric Surgery , Montreal General Hospital, Montreal, Quebec, Canada
                Author notes
                Correspondence should be addressed to J Xu or Q Kang; Email: xujia0117@ 123456126.com or orthokang@ 123456163.com

                *(R Zhang and X Wang contributed equally to this work)

                Article
                EOR-21-0087
                10.1530/EOR-21-0087
                9069855
                35446261
                a77deff2-eced-4227-9c9b-6ad26a0dea26
                © The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                Categories
                Trauma
                trauma, Trauma
                Monteggia Fracture
                Neglected
                Biomechanics
                Diagnosis
                Treatment
                Complication
                Custom metadata
                trauma

                monteggia fracture,neglected,biomechanics,diagnosis,treatment,complication

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