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Missed Pediatric Monteggia Fractures

Hubbard, James MD1,2; Chauhan, Aakash MD, MBA1,a; Fitzgerald, Ryan MD3; Abrams, Reid MD1; Mubarak, Scott MD2; Sangimino, Mark MD4

doi: 10.2106/JBJS.RVW.17.00116
Review Article
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Disclosures

  • * Careful scrutiny of radiographs is important in the assessment of pediatric elbow injuries. Disruption of the radiocapitellar line and an increased bow of the posterior ulnar border are sometimes subtle signs of a Monteggia injury.
  • * An attempt at closed reduction up to 4 weeks after injury has been cited in the literature as successfully treating some missed injuries.
  • * Operative reduction of chronic radial-head dislocation provides good to excellent range of motion and functional outcome in the setting of irreducible chronic radial-head dislocation.
  • * Ulnar osteotomy and correction of the ulnar deformity component of the missed Monteggia injury are the key to indirect anatomic reduction of the radiocapitellar joint.
  • * Supplemental procedures aimed at increasing the stability of the radiocapitellar joint (e.g., annular ligament reconstruction, radiocapitellar Kirschner wire fixation, radioulnar Kirschner wire fixation) should be directed by a thorough assessment of radiocapitellar stability following ulnar osteotomy and correction of the ulnar deformity.

1Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopaedic Surgery, University of California, San Diego (UCSD), San Diego, California

2Department of Pediatric Orthopaedic Surgery, Rady Children’s Hospital, San Diego, California

3Department of Pediatric Orthopaedic Surgery, Riley Children’s Hospital, Indianapolis, Indiana

4Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania

aE-mail address for A. Chauhan: achauhan1000@gmail.com

Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated
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