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VOLUME 2 , ISSUE 1 ( April, 2007 ) > List of Articles

Original

Open reduction and corrective ulnar osteotomy for missed radial head dislocations in children

Denise Eygendaal, R. J. Hillen

Keywords : Elbow, Radial head, Dislocation, Reduction

Citation Information : Eygendaal D, Hillen RJ. Open reduction and corrective ulnar osteotomy for missed radial head dislocations in children. 2007; 2 (1):31-34.

DOI: 10.1007/s11751-007-0013-9

License: CC BY-NC-SA 4.0

Published Online: 01-04-2007

Copyright Statement:  Copyright © 2007; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

The treatment of chronic radial head dislocation remains controversial. Open reduction of the radial head in combination with correction of malalignment with ulnar osteotomy can be the key to a good surgical result. Between 2001 and 2006, 9 (6 female, 3 male, average age 8.4 (5-11) years) patients were treated surgically for chronic radial head dislocation by one surgeon. The time between trauma and surgery was 7 (1.5-14) months. The procedure consisted of open reduction of the dislocated radial head and reconstruction of the annular ligament in combination with an ulnar osteotomy. An upper arm cast was applied with the forearm in neutral rotation for six weeks. Plates were removed in all patients. Clinical and radiological evaluation took place preoperatively and after an average of 23 (10-49) months. At radiograph 8/9 showed a reduced radial head; in one an anterior subluxation was seen. The range of motion remained the same in 4 patients who had a full range of motion preoperatively. In 2/5 patients with loss of range of motion preoperatively, improvement was seen. There were no serious surgical complications beside one infection. Open reduction and corrective ulnar osteotomy shows good results for missed radial head dislocations in children.


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  1. Bado JL (1967) The Monteggia lesion. Clin Orthop Relat Res 50:71-86
  2. Chen WS (1992) Late neuropathy in chronic dislocation of the radial head. Report of two cases. Acta Orthop Scand 63:343-344
  3. Dormans JP, Rang M (1990) The problem of Monteggia fracture- dislocations in children. Orthop Clin North Am 21:251-266
  4. Holst-Nielsen F, Jensen V (1984) Tardy posterior interosseous nerve palsy as a result of an unreduced radial head dislocation in Monteggia fractures: a report of two cases. J Hand Surg 9:572-575
  5. Rodgers WB, Waters PM, Hall JE (1996) Chronic Monteggia lesions in children. Complications and results of reconstruction. J Bone Joint Surg Am 78:1322-1329
  6. Boyd HB, Boals JC (1969) The Monteggia lesion. A review of 159 cases. Clin Orthop Relat Res 66:94-100
  7. Morrey BF, Tanaka S, An KN (1991) Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res 265:187-195
  8. Bell Tawse AJ (1965) The treatment of malunited, anterior Monteggia fractures in children. J Bone Joint Surg Br 47:718-723
  9. Kalamchi A (1986) Monteggia fracture-dislocation in children. Late treatment in two cases. J Bone Joint Surg Am 68:615-619
  10. Oner FC, Diepstraten AF (1993) Treatment of chronic posttraumatic dislocation of the radial head in children. J Bone Joint Surg Br 75:577-581
  11. Ring D, Waters PM (1996) Operative fixation of Monteggia fractures in children. J Bone Joint Surg Br 78:734-739
  12. Kim HT, Conjares JNV, Suh JT, Yoo IC (2001) Chronic head dislocation in Children, Part 1: Pathologic changes preventing stable reduction and surgical correction. J Pediatr Orthop 22:583-590
  13. Best TN (1994) Management of old unreduced Monteggia fracture dislocations of the elbow in children. J Pediatr Orthop 14:193-199
  14. Horii E, Nakamura R, Koh S et al (2002) Surgical treatment for chronic radial head dislocation. J Bone Surg Am 84:1183-1188
  15. Mehta SD (1985) Flexion osteotomy of ulna for untreated Monteggia fracture in children. Ind J Surg 47:15-19
  16. Koslowsky TC, Mader K, Wulke AP et al (2006) Operative treatment of chronic Monteggia lesion in younger children: a report of three cases. J Shoulder Elbow Surg 15:119-121
  17. Freedman L, Luk K, Leong JC (1988) Radial head reduction after a missed Monteggia fracture: brief report. J Bone Joint Surg Br 70:846-847
  18. Stoll TM, Willis, Paterson DC (1992) Treatment of the missed Monteggia fracture in the child. J Bone Joint Surg Br 74:436-440
  19. Hirayama T, Takemitsu Y, Yagihara K, Mikita A (1987) Operation for chronic dislocation of the radial head in children: reduction by osteotomy of the ulna. J Bone Joint Surg Br 69:639-642
  20. Kim HT, Park BG, Suh JT, Yoo IC (2002) Chronic radial head dislocation in children, Part 2: Results of open treatment and factors affecting final outcome. J Pediatr Orthop 22:591-597
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