Combined type III Monteggia fracture dislocation and ipsilateral distal radial epiphyseal fracture is a very rare injury. Because of difficulty in performing the proper clinical evaluation of a child in an acute injur...Combined type III Monteggia fracture dislocation and ipsilateral distal radial epiphyseal fracture is a very rare injury. Because of difficulty in performing the proper clinical evaluation of a child in an acute injury state, one of the components of this combined injury may be missed. We report a ten- year-old male child with this kind of injury where the Monteggia lesion was initially missed at the emergency department. Later we found the combined epiphyseal fracture of distal radius and Monteggia lesion in the ipsilateral side of the same limb which was managed by closed reduction and K-wire fixation. Bony union as well as wrist and elbow motion was complete 3 months after surgical intervention.展开更多
Purpose:To evaluate the efficacy of closed reduction on the humeroradial joint in the treatment of Bado typeⅠ,ⅡandⅢfresh Monteggia fractures in children and investigate the effect of clinical factors,including Bado...Purpose:To evaluate the efficacy of closed reduction on the humeroradial joint in the treatment of Bado typeⅠ,ⅡandⅢfresh Monteggia fractures in children and investigate the effect of clinical factors,including Bado classification,age and time of treatment on the success rate of closed reduction.Methods:We retrospectively studied the data of children<10 years old with fresh Monteggia fractures(injury within two weeks)treated by manual reduction with plaster immobilization from January 2014 to April 2019.All patients were followed up in the outpatient department every two weeks for 4-6 weeks until plaster removal and then 3,6 and 12 months.Online or telephone interview was provided for some inconvenient patients after 6 months.Mackay criteria were used to evaluate the clinical effect.Radiographic data were collected and reviewed to assess the reduction of the humeroradial joint.Function of the elbow joint and forearm was evaluated and risk factors related to the failure of reduction were assessed.The successful manual reduction was analyzed from three aspects,respectively Bado fracture type(Ⅰ,Ⅱ,Ⅲ),patient age(<3 year,3-6 years,>6 years)and time interval from injury to treatment(group A,<1 day;group B,1-3 days;group C,>3 days).Results:Altogether 88 patients were employed in this study,including 58 males(65.9%)and 30 females(34.1%)aged from 1 to 10 years.There were 29 cases(33.0%)of Bado typeⅠMonteggia fractures,16(18.2%)typeⅡand 43(48.7%)typeⅢ.Successful manual reduction was achieved in 79 children(89.8%)at the last follow-up.The failed 9 patients received open surgery.Mackay criteria showed 100%goodexcellent rate for all the patients.The success rate of manual reduction was 89.7%,87.5%and 90.7%in Bado typeⅠ,ⅡandⅢcases,respectively,revealing no significant differences among different Bado types(x2=0.131,p=0.937).Successful closed reduction was achieved in 13 toddlers(13/13,100%),38 preschool children(28/42,90.5%)and 28 school-age children(28/33,84.8%),suggesting no significant difference eith展开更多
Objective： Monteggia fracture disloca- tion equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mec...Objective： Monteggia fracture disloca- tion equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a re- view of the literature. Methods： A retrospective record of Monteggia frac- ture dislocation （2003-2008） was reviewed from medical record department of our institute. Classic Monteggia frac- ture dislocation, children below 12 years or adults over 50 years, as well as open grade iI ＆ Ill cases were excluded from this study. Monteggia variant inclusion criteria in- cluded fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 fe- males with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients. Results： Follow-up ranged from 1-4 years, mean 2.6 years. Patients were assessed clinicoradiologically. MayoElbow Performance Score outcomes. At final follow-up, was employed to assess the the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20°, 116°, 50° and 55° for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures. Conclusions： Monteggia fracture dislocation equiva- lents are rare injuries and pr展开更多
Stable and painless elbow motion is essential for activities of daily living. The elbow joint is the second most commonly dislocated joint in adults. The goals of treatment are to perform a stable fixation of all frac...Stable and painless elbow motion is essential for activities of daily living. The elbow joint is the second most commonly dislocated joint in adults. The goals of treatment are to perform a stable fixation of all fractures, to achieve concentric and stable reduction of the elbow and to provide early motion. The treatment modality for complex elbow instability is almost always surgical. The treatment objectives are anatomic reduction, stable fixation, and early rehabilitation of the elbow. The common complications of these unstablefractures include recurrent instability, stiffness, myositis ossifications, heterotopic calcification, and neurovascular dysfunction. We analyzed the management of complex elbow fractures and instabilities on the basis of recent literature and suggested possible guidelines for the treatment in this paper. In conclusion, recognition of the injury pattern and restoration of the joint stability are the prerequisites for any successful treatment of an unstable elbow injury.展开更多
Objective： Although most of nerve in- juries associated with Monteggia fracture-dislocation in children are neurapraxias and will recover spontaneously after conservative treatment, surgical exploration of the in- vo...Objective： Although most of nerve in- juries associated with Monteggia fracture-dislocation in children are neurapraxias and will recover spontaneously after conservative treatment, surgical exploration of the in- volved nerve is always required in the cases with the en- trapment of posterior interosseous nerve （PIN）. However, the necessity and time frame for surgical intervention for specific patterns of nerve dysfunction remains controversial. The aim of the report is to observe and understand the pathology of PIN injury associated with Monteggia frac- ture-dislocation in children, and to propose the possible indication for the exploration of nerve. Methods： Eight cases, six boys and two girls, with Monteggia fracture-dislocation complicated by PIN injury, managed operatively at the authors＇ Hospital from 2007 to 2008 were retrospectively reviewed. All the patients under- went the attempted closed reduction before they received exploration of PIN, with open reduction and intemal fixation or successful closed reduction. Results： The PIN was found to be trapped acutely posterior to the radiocapitellar joint in 4 out of 5 Type IlI Bado＇s Monteggia fractures. In the remaining cases, since there were longer time intervals from injury to operation, chronic compressive changes and epineural fibrosis of ra- dial nerve were visualized. After a microsurgical neurolysis performed, the complete recovery in the nerve function was obtained in all the cases during the follow-up. Conclusion： The findings from this study suggest that every case of type III Monteggia fracture-dislocation with decreased or absent function of muscles innervated by PIN and an irreducible radial head in children should be viewed as an indication for immediate surgical exploration of the involved nerve to exclude a potential PIN entrapment.展开更多
BACKGROUND Monteggia and equivalent lesions are relatively rare but result in severe injuries in childhood,typically affecting children between 4 and 10 years old.The diagnosis and treatment of an equivalent Monteggia...BACKGROUND Monteggia and equivalent lesions are relatively rare but result in severe injuries in childhood,typically affecting children between 4 and 10 years old.The diagnosis and treatment of an equivalent Monteggia lesion is more complicated than those of a typical Monteggia fracture.This type of lesion may be challenging and may lead to serious complications if not treated properly.Pediatric Monteggia equivalent type I lesions have been reported in a few reports,all of which the patients were all over 4 years old.CASE SUMMARY A 14-mo-old boy was referred to our clinic after falling from his bed 10 d prior.With regard to the clinical examination,an obvious swollen and angular deformity was noted on his right forearm.Plain radiographs and reconstructed computed tomography scans showed a Monteggia type I fracture and dislocation.Magnetic resonance imaging(MRI)confirmed a type I Monteggia equivalent lesion consisting of ulnar fracture and Salter-Harris type I injury in the proximal radius.The radial head was still in the joint,and only the radial metaphysis was displaced anteriorly.Open reduction and pinning of both displaced radial and ulnar fractures achieved an excellent result with full function.CONCLUSION We recommend MRI examination or arthrography during reduction,especially if the secondary ossification center has not appeared.展开更多
Treatment of infected forearm nonunion and defects represents a difficult task for the operating sur-geons.Conventional methods like composite and vascularized fibular grafts and the induced membranes filled with canc...Treatment of infected forearm nonunion and defects represents a difficult task for the operating sur-geons.Conventional methods like composite and vascularized fibular grafts and the induced membranes filled with cancellous autografts or the Masquelet technique have been reported to be useful and suc-cessful,but sometimes it is difficult to predict the outcome and cannot address simultaneous deformities or the need to apply gradual distraction for reduction of a chronically dislocated radial head.Ilizarov technique has an answer for such conditions.We report a 43 years old man with infected ulnar defect and dislocated radial head as a result of infected Monteggia fracture:the patient was successfully treated by Ilizarov bone transport after failed attempts by bone spacer and fibular graft.展开更多
Introduction: Homolateral combined fractures of Monteggia and Galeazzi are very rare. Their treatment is exclusively surgical and should be proposed early in order to restore the anatomy of the antebrachial skeleton, ...Introduction: Homolateral combined fractures of Monteggia and Galeazzi are very rare. Their treatment is exclusively surgical and should be proposed early in order to restore the anatomy of the antebrachial skeleton, pronosupination, and the flexion-extension of the elbow and wrist. Observation: We reported the case of a 45-year-old woman who presented a homolateral fracture of Monteggia and Galeazzi following a road accident. This combination of fractures posed a problem of diagnosis and management. Surgical follow-up presented functional issues. Conclusion: The association of Monteggia and Galeazzi fracture is very rare and poorly reported in the literature. This observation reminds us of the importance of performing a complete clinical and paraclinical assessment before any therapeutic decision.展开更多
The authors report a rare case of Monteggia bilateral fracture combining bifocal fracture of the left ulna to a mid-shaft fracture of the radius with dislocation of the radial head and on the right;a fractured ulna wi...The authors report a rare case of Monteggia bilateral fracture combining bifocal fracture of the left ulna to a mid-shaft fracture of the radius with dislocation of the radial head and on the right;a fractured ulna with dislocation of the radial head occurring in a patient of 31 years after an accident of the public highway. In emergency, the treatment consisted of a fixation with radius special plates and a left pin ulnar upper radio. The evolution was marked by a good consolidation and after six months the patient had resumed operations.展开更多
Single bone forearm fractures are usually associated with dislocation of one radio-ulnar joint. The association of ulnar fractures with dislocation of proximal radio-ulnar joint and radius fractures with distal radio-...Single bone forearm fractures are usually associated with dislocation of one radio-ulnar joint. The association of ulnar fractures with dislocation of proximal radio-ulnar joint and radius fractures with distal radio-ulnar joint is well described. Classically they are better known as Monteggia and Galeazzi fracture dislocations respectively. These peculiar presentations are attributed to intricate relationship of the forearm bones joined together as a unit by two radio-ulnar joints at proximal and distal ends and the interosseous membrane in the middle part. However, simultaneous dislocation of the both radio-ulnar joints associated with fracture of single bone is a very rare event. Literature search does not reveal a single case of such type. We are presenting here a case of fracture shaft of radius associated with dislocation of both proximal and distal radio-ulnar joints. The patient was managed by open reduction and fixation of the radius by a compression plate and the dislocations were reduced by closed method and stabilized with small K wires.展开更多
A rare combination of an ulnar fracture with posterior dislocation of the head of the radius and fracture of the radius shaft concomitant with an ipsilateral scaphoid fracture is presented. To the best of our knowledg...A rare combination of an ulnar fracture with posterior dislocation of the head of the radius and fracture of the radius shaft concomitant with an ipsilateral scaphoid fracture is presented. To the best of our knowledge, no such case has been reported. The mechanism of this fracture combination is discussed with respect to its role in producing the Monteggia type II fracture. Treatment consisted of a combination of closed and open reduction with external fixation.展开更多
文摘Combined type III Monteggia fracture dislocation and ipsilateral distal radial epiphyseal fracture is a very rare injury. Because of difficulty in performing the proper clinical evaluation of a child in an acute injury state, one of the components of this combined injury may be missed. We report a ten- year-old male child with this kind of injury where the Monteggia lesion was initially missed at the emergency department. Later we found the combined epiphyseal fracture of distal radius and Monteggia lesion in the ipsilateral side of the same limb which was managed by closed reduction and K-wire fixation. Bony union as well as wrist and elbow motion was complete 3 months after surgical intervention.
基金the Key Project of Chongqing Health Planning Commission of Research Fund(No.2019ZDXM047)Chongqing science and technology commission basic and frontier exploration general project(No.cstc2018jcyjAX0259)Yuzhong science and technology commission basic and frontier exploration general project(No.20180115).
文摘Purpose:To evaluate the efficacy of closed reduction on the humeroradial joint in the treatment of Bado typeⅠ,ⅡandⅢfresh Monteggia fractures in children and investigate the effect of clinical factors,including Bado classification,age and time of treatment on the success rate of closed reduction.Methods:We retrospectively studied the data of children<10 years old with fresh Monteggia fractures(injury within two weeks)treated by manual reduction with plaster immobilization from January 2014 to April 2019.All patients were followed up in the outpatient department every two weeks for 4-6 weeks until plaster removal and then 3,6 and 12 months.Online or telephone interview was provided for some inconvenient patients after 6 months.Mackay criteria were used to evaluate the clinical effect.Radiographic data were collected and reviewed to assess the reduction of the humeroradial joint.Function of the elbow joint and forearm was evaluated and risk factors related to the failure of reduction were assessed.The successful manual reduction was analyzed from three aspects,respectively Bado fracture type(Ⅰ,Ⅱ,Ⅲ),patient age(<3 year,3-6 years,>6 years)and time interval from injury to treatment(group A,<1 day;group B,1-3 days;group C,>3 days).Results:Altogether 88 patients were employed in this study,including 58 males(65.9%)and 30 females(34.1%)aged from 1 to 10 years.There were 29 cases(33.0%)of Bado typeⅠMonteggia fractures,16(18.2%)typeⅡand 43(48.7%)typeⅢ.Successful manual reduction was achieved in 79 children(89.8%)at the last follow-up.The failed 9 patients received open surgery.Mackay criteria showed 100%goodexcellent rate for all the patients.The success rate of manual reduction was 89.7%,87.5%and 90.7%in Bado typeⅠ,ⅡandⅢcases,respectively,revealing no significant differences among different Bado types(x2=0.131,p=0.937).Successful closed reduction was achieved in 13 toddlers(13/13,100%),38 preschool children(28/42,90.5%)and 28 school-age children(28/33,84.8%),suggesting no significant difference eith
文摘Objective： Monteggia fracture disloca- tion equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a re- view of the literature. Methods： A retrospective record of Monteggia frac- ture dislocation （2003-2008） was reviewed from medical record department of our institute. Classic Monteggia frac- ture dislocation, children below 12 years or adults over 50 years, as well as open grade iI ＆ Ill cases were excluded from this study. Monteggia variant inclusion criteria in- cluded fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 fe- males with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients. Results： Follow-up ranged from 1-4 years, mean 2.6 years. Patients were assessed clinicoradiologically. MayoElbow Performance Score outcomes. At final follow-up, was employed to assess the the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20°, 116°, 50° and 55° for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures. Conclusions： Monteggia fracture dislocation equiva- lents are rare injuries and pr
文摘Stable and painless elbow motion is essential for activities of daily living. The elbow joint is the second most commonly dislocated joint in adults. The goals of treatment are to perform a stable fixation of all fractures, to achieve concentric and stable reduction of the elbow and to provide early motion. The treatment modality for complex elbow instability is almost always surgical. The treatment objectives are anatomic reduction, stable fixation, and early rehabilitation of the elbow. The common complications of these unstablefractures include recurrent instability, stiffness, myositis ossifications, heterotopic calcification, and neurovascular dysfunction. We analyzed the management of complex elbow fractures and instabilities on the basis of recent literature and suggested possible guidelines for the treatment in this paper. In conclusion, recognition of the injury pattern and restoration of the joint stability are the prerequisites for any successful treatment of an unstable elbow injury.
文摘Objective： Although most of nerve in- juries associated with Monteggia fracture-dislocation in children are neurapraxias and will recover spontaneously after conservative treatment, surgical exploration of the in- volved nerve is always required in the cases with the en- trapment of posterior interosseous nerve （PIN）. However, the necessity and time frame for surgical intervention for specific patterns of nerve dysfunction remains controversial. The aim of the report is to observe and understand the pathology of PIN injury associated with Monteggia frac- ture-dislocation in children, and to propose the possible indication for the exploration of nerve. Methods： Eight cases, six boys and two girls, with Monteggia fracture-dislocation complicated by PIN injury, managed operatively at the authors＇ Hospital from 2007 to 2008 were retrospectively reviewed. All the patients under- went the attempted closed reduction before they received exploration of PIN, with open reduction and intemal fixation or successful closed reduction. Results： The PIN was found to be trapped acutely posterior to the radiocapitellar joint in 4 out of 5 Type IlI Bado＇s Monteggia fractures. In the remaining cases, since there were longer time intervals from injury to operation, chronic compressive changes and epineural fibrosis of ra- dial nerve were visualized. After a microsurgical neurolysis performed, the complete recovery in the nerve function was obtained in all the cases during the follow-up. Conclusion： The findings from this study suggest that every case of type III Monteggia fracture-dislocation with decreased or absent function of muscles innervated by PIN and an irreducible radial head in children should be viewed as an indication for immediate surgical exploration of the involved nerve to exclude a potential PIN entrapment.
文摘BACKGROUND Monteggia and equivalent lesions are relatively rare but result in severe injuries in childhood,typically affecting children between 4 and 10 years old.The diagnosis and treatment of an equivalent Monteggia lesion is more complicated than those of a typical Monteggia fracture.This type of lesion may be challenging and may lead to serious complications if not treated properly.Pediatric Monteggia equivalent type I lesions have been reported in a few reports,all of which the patients were all over 4 years old.CASE SUMMARY A 14-mo-old boy was referred to our clinic after falling from his bed 10 d prior.With regard to the clinical examination,an obvious swollen and angular deformity was noted on his right forearm.Plain radiographs and reconstructed computed tomography scans showed a Monteggia type I fracture and dislocation.Magnetic resonance imaging(MRI)confirmed a type I Monteggia equivalent lesion consisting of ulnar fracture and Salter-Harris type I injury in the proximal radius.The radial head was still in the joint,and only the radial metaphysis was displaced anteriorly.Open reduction and pinning of both displaced radial and ulnar fractures achieved an excellent result with full function.CONCLUSION We recommend MRI examination or arthrography during reduction,especially if the secondary ossification center has not appeared.
文摘Treatment of infected forearm nonunion and defects represents a difficult task for the operating sur-geons.Conventional methods like composite and vascularized fibular grafts and the induced membranes filled with cancellous autografts or the Masquelet technique have been reported to be useful and suc-cessful,but sometimes it is difficult to predict the outcome and cannot address simultaneous deformities or the need to apply gradual distraction for reduction of a chronically dislocated radial head.Ilizarov technique has an answer for such conditions.We report a 43 years old man with infected ulnar defect and dislocated radial head as a result of infected Monteggia fracture:the patient was successfully treated by Ilizarov bone transport after failed attempts by bone spacer and fibular graft.
文摘Introduction: Homolateral combined fractures of Monteggia and Galeazzi are very rare. Their treatment is exclusively surgical and should be proposed early in order to restore the anatomy of the antebrachial skeleton, pronosupination, and the flexion-extension of the elbow and wrist. Observation: We reported the case of a 45-year-old woman who presented a homolateral fracture of Monteggia and Galeazzi following a road accident. This combination of fractures posed a problem of diagnosis and management. Surgical follow-up presented functional issues. Conclusion: The association of Monteggia and Galeazzi fracture is very rare and poorly reported in the literature. This observation reminds us of the importance of performing a complete clinical and paraclinical assessment before any therapeutic decision.
文摘The authors report a rare case of Monteggia bilateral fracture combining bifocal fracture of the left ulna to a mid-shaft fracture of the radius with dislocation of the radial head and on the right;a fractured ulna with dislocation of the radial head occurring in a patient of 31 years after an accident of the public highway. In emergency, the treatment consisted of a fixation with radius special plates and a left pin ulnar upper radio. The evolution was marked by a good consolidation and after six months the patient had resumed operations.
文摘Single bone forearm fractures are usually associated with dislocation of one radio-ulnar joint. The association of ulnar fractures with dislocation of proximal radio-ulnar joint and radius fractures with distal radio-ulnar joint is well described. Classically they are better known as Monteggia and Galeazzi fracture dislocations respectively. These peculiar presentations are attributed to intricate relationship of the forearm bones joined together as a unit by two radio-ulnar joints at proximal and distal ends and the interosseous membrane in the middle part. However, simultaneous dislocation of the both radio-ulnar joints associated with fracture of single bone is a very rare event. Literature search does not reveal a single case of such type. We are presenting here a case of fracture shaft of radius associated with dislocation of both proximal and distal radio-ulnar joints. The patient was managed by open reduction and fixation of the radius by a compression plate and the dislocations were reduced by closed method and stabilized with small K wires.
文摘A rare combination of an ulnar fracture with posterior dislocation of the head of the radius and fracture of the radius shaft concomitant with an ipsilateral scaphoid fracture is presented. To the best of our knowledge, no such case has been reported. The mechanism of this fracture combination is discussed with respect to its role in producing the Monteggia type II fracture. Treatment consisted of a combination of closed and open reduction with external fixation.
