Volume 10, Issue 4 (In-Press 2023)
JROS 2023, 10(4): 0-0 |
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Najd Mazhar F, Hasan A, Sadeghzadeh M, Mahmoudinasab O. Irreducible radial head dislocation in pediatric patients with Monteggia fracture: A series of nine patients. JROS 2023; 10 (4)
URL: http://jros.iums.ac.ir/article-1-2250-en.html
URL: http://jros.iums.ac.ir/article-1-2250-en.html
Abstract: (64 Views)
Background: In pediatrics with Monteggia fractures, anatomical reduction of the ulna generally results in spontaneous radial head reduction. However, spontaneous reduction of the radial head does not occur in some patients for various reasons. The characteristic features of this condition, particularly in the pediatric population, are rarely reported. In this study, we report characteristic features in nine pediatric patients with irreducible radial heads in the context of Monteggia fracture.
Methods: Medical profiles of nine skeletally immature patients with Monteggia fractures who underwent surgery for the treatment of irreducible radial head dislocation between 2007 and 2024 were retrospectively reviewed. Eight patients were presented with initial injury, and one patient with a re-dislocation following initial management in another center. The main finding of interest was the cause of radial head irreducibility.
Results: The study population included seven (77.8%) males and two (22.2%) females with a mean age of 5.9±4.1 years. The mechanism of injury was falling down in all patients. Four (44.4%) patients had associated injuries. The most frequent site of ulnar fracture was proximal ulna (n=5, 55.5%). Oblique fracture was the most common type of ulnar fracture (n=7, 77.8%). In all patients, the radial head was dislocated anteriorly. The cause of irreducibility was interposed annular ligament in seven (77.8%) patients and interposed posterior interosseous nerve in two (22.2%) patients. No postoperative complications, including radial head re-dislocation or subluxation, were found until the last follow-up visit.
Conclusion: Spontaneous reduction of the radial head in the context of Monteggia fracture might not occur in a subset of pediatric patients, requiring an open reduction to adequately address the cause of irreducibility. The interposed annular ligament seems to be the most frequent cause of irreducibility in this population.
Methods: Medical profiles of nine skeletally immature patients with Monteggia fractures who underwent surgery for the treatment of irreducible radial head dislocation between 2007 and 2024 were retrospectively reviewed. Eight patients were presented with initial injury, and one patient with a re-dislocation following initial management in another center. The main finding of interest was the cause of radial head irreducibility.
Results: The study population included seven (77.8%) males and two (22.2%) females with a mean age of 5.9±4.1 years. The mechanism of injury was falling down in all patients. Four (44.4%) patients had associated injuries. The most frequent site of ulnar fracture was proximal ulna (n=5, 55.5%). Oblique fracture was the most common type of ulnar fracture (n=7, 77.8%). In all patients, the radial head was dislocated anteriorly. The cause of irreducibility was interposed annular ligament in seven (77.8%) patients and interposed posterior interosseous nerve in two (22.2%) patients. No postoperative complications, including radial head re-dislocation or subluxation, were found until the last follow-up visit.
Conclusion: Spontaneous reduction of the radial head in the context of Monteggia fracture might not occur in a subset of pediatric patients, requiring an open reduction to adequately address the cause of irreducibility. The interposed annular ligament seems to be the most frequent cause of irreducibility in this population.
Type of Study: Research Article |
Subject:
Hand surgery / Elbow
Received: 2024/07/4 | Accepted: 2024/12/7 | Published: 2023/11/19
Received: 2024/07/4 | Accepted: 2024/12/7 | Published: 2023/11/19
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