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Impact of Open Reduction on Surgical Strategies for Missed Monteggia Fracture in Children.

 Hoon Park  ;  Kwang-Won Park  ;  Kun Bo Park  ;  Hyun Woo Kim  ;  Nam Kyu Eom  ;  Dong Hoon Lee 
 Yonsei Medical Journal, Vol.58(4) : 829-836, 2017 
Journal Title
 Yonsei Medical Journal 
Issue Date
Adolescent ; Child ; Child, Preschool ; Elbow Joint/diagnostic imaging ; Elbow Joint/physiopathology ; Elbow Joint/surgery ; Female ; Humans ; Male ; Monteggia's Fracture/diagnostic imaging ; Monteggia's Fracture/physiopathology ; Monteggia's Fracture/surgery* ; Open Fracture Reduction* ; Postoperative Care ; Preoperative Care ; Radius/diagnostic imaging ; Radius/surgery ; Range of Motion, Articular ; Retrospective Studies ; Ulna/physiopathology ; Ulna/surgery
Missed Monteggia fracture ; open reduction ; ulnar bow ; ulnar osteotomy
PURPOSE: The aims of this study were to review our cases of missed Monteggia fracture treated by open reduction of the radial head with or without ulnar osteotomy and to investigate the indications for open reduction alone in surgical treatment of missed Monteggia fracture. MATERIALS AND METHODS: We retrospectively reviewed 22 patients who presented with missed Monteggia fracture. The patients' mean age at the time of surgery was 7.6 years. The mean interval from injury to surgery was 16.1 months. The surgical procedure consisted of open reduction of the radiocapitellar joint followed by ulnar osteotomy without reconstruction of the annular ligament. The mean period of follow-up was 3.8 years. Radiographic assessment was performed for the maximum ulnar bow (MUB) and the location of the MUB. Clinical results were evaluated with the Mayo Elbow Performance Index and Kim's scores. RESULTS: Five patients underwent open reduction alone, and 17 patients underwent open reduction and ulnar osteotomy. When the MUB was less than 4 mm and the location of the MUB was in the distal 40% of the ulna, we could achieve reduction of the radial head without ulnar osteotomy. The radial head was maintained in a completely reduced position in 21 patients and was dislocated in one patient at final follow-up. CONCLUSION: Open reduction alone can be an attractive surgical option in select patients with missed Monteggia fracture with minimal bowing of the distal ulna. However, ulnar osteotomy should be considered in patients with a definite ulnar deformity.
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
김현우(Kim, Hyun Woo) ORCID logo https://orcid.org/0000-0001-8576-1877
박건보(Park, Kun Bo) ORCID logo https://orcid.org/0000-0002-8839-4870
박훈(Park, Hoon) ORCID logo https://orcid.org/0000-0002-8063-3742
엄남규(Eom, Nam Kyu)
이동훈(Lee, Dong Hoon)
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