Ulus Travma Acil Cerrahi Derg. 2023; 29(6): 724-732 | DOI: 10.14744/tjtes.2022.52042

Functional outcomes of pediatric true and equivalent Monteggia fractures – Review of the literature

Lercan Aslan¹, Cemil Cihad Gedik², Olgar Birsel², Ilker Eren², Emel Gönen², Mehmet Demirhan^2
1Koc University Hospital, Orthopaedics and Traumatology Department, Istanbul-Türkiye
²Koc University School of Medicine, Orthopaedics and Traumatology Department, Istanbul-Türkiye

BACKGROUND: This study aims to describe the functional outcome of true and equivalent Monteggia fracture-dislocations in the pediatric population. We also provided a review of the literature about the treatment options.
METHODS: Five surgically and three conservatively treated patients were identified who were treated in 2009-2021. The study pop-ulation consisted of six female and two male patients. The mean age at the time of treatment was 7. The mean follow-up time was 55 months (range, 12–128). The Mayo Elbow Performance Score and the Oxford Elbow Score were used for outcome evaluation. Range of motion and grip strengths were also evaluated.
RESULTS: There were two Bado type 1 and six Monteggia equivalent injuries. Closed reduction and casting were utilized for the two Bado type 1 injuries as the initial treatment. However, one had a radial head re-dislocation and had to be treated operatively. This patient had a radial head re-dislocation after the surgery and was followed up conservatively. Three Monteggia equivalent injuries were treated with closed reduction and casting, with no complications. One patient had a radial head anterior dislocation with plastic deformation of the ulna, and this patient was managed with CORA-based corrective ulnar osteotomy. For Monteggia injuries, the main treatment objective is to restore the ulnar length. Bilateral computed tomography imaging with 3D reconstruction can be utilized in preoperative planning of Monteggia fracture-dislocations to customize the treatment. Close observation is essential to detect radial head subluxation, which needs early intervention before irreversible changes occur.
CONCLUSION: The true/equivalent Monteggia fractures’ main treatment goal is to restore the ulnar length. Conservative treatment, with a close follow-up, is the first option if closed reduction can be achieved. If closed reduction is not possible, careful preop-erative planning and early rehabilitation are key to success for management of Monteggia fractures.

Keywords: Monteggia, Monteggia equivalents; pediatric fractures; upper extremity deformity.

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Pediatrik gerçek ve ekivalan Monteggia kýrýklarýnda fonksiyonel sonuçlar ve güncel literatüre bakýþ

Lercan Aslan¹, Cemil Cihad Gedik², Olgar Birsel², Ilker Eren², Emel Gönen², Mehmet Demirhan^2
1Koç Üniversitesi Hastanesi, Ortopedi ve Travmatoloji Anabilim Dalý, Ýstanbul
²Koç Üniversitesi Týp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalý, Istanbul

AMAÇ: Bu çalýþmanýn amacý, pediatrik popülasyonda gerçek ve ekivalan Monteggia kýrýklý çýkýklarýndaki fonksiyonel sonuçlarýmýzýn bildirilmesidir. Bunun yanýnda tedavi seçenekleri hakkýnda bir literatür incelemesi de yaptýk.
GEREÇ VE YÖNTEM: 2009-2021 tarihleri arasýnda beþi cerrahi, üçü konservatif tedavi edilen hasta saptandý. Bu hastalarýn altýsý kýz çocuðu, ikisi ise erkek çocuðuydu. Tedavi anýnda ortalama yaþ 7 idi. Ortalama takip süresi 55 hafta (aralýk, 12-128) olarak bulundu. Mayo Elbow Performance Score (MEPS) ve Oxford Elbow Score (OES) sonuçlarýn deðerlendirilmesinde kullanýldý. Eklem hareket açýklýðý ve kavrama güçleri de deðerlendirildi.
BULGULAR: Bu sekiz hastada, iki Bado tip 1 ve altý Monteggia ekivalan yaralanmasý saptandý. Bado tip 1 yaralanmalar için kapalý redüksiyon ve alçýlama birincil tedavi olarak kullanýldý. Fakat bu hastalarýn birinde redislokasyon geliþmesi üzerine cerrahi tedaviye geçildi. Ayný hastada cerrahi son-rasýnda ikinci kere dislokasyon geliþmesi üzerine konservatif tedaviyle takip edildi. Üç Monteggia ekivalan yaralanma kapalý redüksiyon ve alçýlama ile komplikasyonsuz tedavi edildi. Bir hastada ulnanýn plastik deformasyonuyla beraber radius baþýnýn anterior çýkýðý vardý ve bu hastada CORA’ya uygun düzeltici ulnar osteotomi uygulandý.
TARTIÞMA: Monteggia yaralanmalarý için ana tedavi yöntemi ulnar uzunluðun geri kazanýlmasýdýr. 3 boyutlu rekonstrüksiyonlu bilateral BT görüntüleme tedaviyi hastaya göre özelleþtirmek için preoperatif planlamada kullanýlabilir. Radius baþý subluksasyonunun erken tespiti ve gereken giriþimin yapýlmasý için geç kalýnmamasý amacýyla yakýn gözlem elzemdir.

Anahtar Kelimeler: Monteggia, Monteggia ekivalan; pediatrik kýrýk; üst ekstremite deformitesi.

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