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Chronic Monteggia Injuries

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Pediatric Elbow Fractures

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Abstract

Traumatic radiocapitellar dislocations that remain unreduced for more than 4 weeks are usually irreducible by closed means and are considered chronic Monteggia injuries (Fig. 14.1) [1]. The term “Monteggia fracture-dislocation” refers to all fractures of the ulna, irrespective of their location, that are associated with dislocation of the radial head. Monteggia fracture-dislocations are uncommon injuries that only account for about 1% of all pediatric forearm fractures [2, 3]. Despite its overall rarity, this injury is one of the most frequently missed injuries in children. Misdiagnosis is because the radial head dislocation is often overlooked and associated with plastic deformation of the ulna [1, 4]. An estimated 33% of acute Monteggia injuries are missed, making it the most common cause of chronic radial head subluxation [1, 5]. Another source of chronic injury is the loss of reduction following closed treatment, which can be seen in up to 20% of cases, especially when the ulnar fracture is oblique [1, 5–7].

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Authors and Affiliations

  1. Hospital Sant Joan de Deu, Barcelona, Spain

    Francisco Soldado M.D., Ph.D.

  2. Shriners Hospital for Children—Philadelphia, Philadelphia, PA, USA

    Scott H. Kozin M.D.

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  1. Francisco Soldado M.D., Ph.D.
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  2. Scott H. Kozin M.D.
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Correspondence to Scott H. Kozin M.D. .

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Editors and Affiliations

  1. Departments of Orthopedics and Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA

    Joshua M. Abzug

  2. St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA

    Martin J. Herman

  3. Shriners Hospitals for Children, Philadelphia, Pennsylvania, USA

    Scott Kozin

Electronic Supplementary Materials

Elbow and forearm anatomy specimen. An ulnar fracture was performed. To obtain a radial head dislocation, section of the annular and quadrangular ligament was necessary. Section of the proximal interosseous membrane was not necessary to obtain a Monteggia-like injury. Depending on the spatial angulation of the ulna, different types of Monteggia injuries can be obtained. https://vimeo.com/183622020 (MP4 7305 kb)

Patient B. 6-year-old chronic Bado and Letts Type-1 Monteggia (see Fig. 14.2). Although elbow and forearm range of motion is grossly preserved, there is a progressive forearm valgus deformity and medial elbow laxity. Over time, an elbow arthritis might be developed. https://vimeo.com/183622022 (MOV 2476 kb)

Patient A. Intraoperative video. The radial head has been reduced but is unstable with forearm rotation. https://vimeo.com/183622023 (MOV 23544 kb)

Patient A. Intraoperative video. Ulnar flexion allows proximal radius (radial head) realignment. https://vimeo.com/183622024 (MOV 10257 kb)

Patient A. The ulnar osteotomy has been prefixated with a KW. The amount of ulnar flexion and distraction is estimated depending on the stability of the radial head tested by performing forearm rotation. https://vimeo.com/183622025 (MOV 20916 kb)

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Soldado, F., Kozin, S.H. (2018). Chronic Monteggia Injuries. In: Abzug, J., Herman, M., Kozin, S. (eds) Pediatric Elbow Fractures. Springer, Cham. https://doi.org/10.1007/978-3-319-68004-0_14

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