Modified surgical technique for missed Monteggia lesions
Monteggia fractures are fairly common in children between 4 and 10 years old, but signs of the initial injury are often missed on x-ray. Misdiagnosis leads to continued pain and limited range of motion. In the longer term, the patient may develop elbow instability, neurological problems, and deformity.
Numerous surgical techniques have been advocated to reconstruct long-standing Monteggia injures in order to maximize long-term upper limb function. Surgeons in the Boston Children’s HospitalHand and Orthopedic Upper Extremity Program, led byDonald S. Bae, MD, recently reported results of a modified surgical technique for missed Monteggia fracture-dislocations.
The modified technique, described in detail in astudypublished in the小儿骨科杂志, includes careful identification and protection of the radial nerve to reduce the risk of nerve injury. If ulna correction is required, rigid fixation helps prevent recurrent displacement of the radial head. Another element, annular ligament repair or reconstruction, further maximizes the chance of long-term elbow stability and function.
Following the procedure, patients demonstrated improved elbow flexion and range of motion in the elbow and forearm. The study reported significant improvements in elbow flexion and forearm supination. Congruent radiocapitellar alignment was maintained in 75 percent of the patients studied.
早期检测和治疗的重要性
尽管这项研究表明，重建后绝大多数患者都表现良好，但及时准确诊断急性蒙特型骨折仍然是恢复上臂功能的最佳方法。为此，每当患者出现近端尺骨骨折时，都会鼓励高度怀疑的高指数和仔细的，系统的放射学评估方法，尤其是在患者是小孩的情况下。
When treating chronic Monteggia lesions, surgeons should be aware of the possibility that the shape of a dislocated radial head could change as the child grows. Therefore, even if the patient’s symptoms are mild, there may be a finite window of opportunity to reconstruct a missed Monteggia lesion and prevent long-term disability.
Article referenced
ET Zheng, PM Waters, CB Vuillermin, K Williams, DS Bae,Surgical Reconstruction of Missed Monteggia Lesions in Children. Journal of Pediatric Orthopaedics, Nov/Dec 2020;40(10).