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Orthop Traumatol Surg Res. 2014 Nov;100(7):803-7. doi: 10.1016/j.otsr.2014.06.022. Epub 2014 Oct 7.

Proximal ulnar osteotomy in the treatment of neglected childhood Monteggia lesion.

Author information

1
Service d'orthopédie infantile, hôpital Trousseau, 26, avenue Netter, 75012 Paris, France.
2
Service d'orthopédie infantile, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille, France.
3
Service d'orthopédie infantile, hôpital des Enfants, 30, avenue de Grande-Bretagne - TSA 70034, 31059 Toulouse cedex 9, France.
4
Service d'orthopédie infantile, hôpital Lapeyronie, 371, avenue du Doyen Gaston-Giraud, 34295 Montpellier, France.
5
Service d'orthopédie infantile, hôpital Lapeyronie, 371, avenue du Doyen Gaston-Giraud, 34295 Montpellier, France. Electronic address: jerome.cottalorda@gmail.com.

Abstract

INTRODUCTION:

The aim of our study was to analyze medium and long-term results of proximal ulnar osteotomy with and without ligament injury in neglected Monteggia injury in children.

MATERIAL AND METHODS:

This retrospective, multicenter study included 28 patients. Clinical criteria concerned the range of motion, pain and MEPI score, and radiologic criteria comprised of Storen line, head-neck ratio, radial neck angle, and signs of osteoarthritic remodeling.

RESULTS:

Twenty-eight patients were reviewed, at a mean 6 years' follow-up (range, 2-34y). Sixteen had proximal ulnar osteotomy without ligament reconstruction, and 12 had associated ligamentoplasty. Both groups showed significant clinical and radiological improvement, with no significant difference. Patients operated within less than 1 year had better clinical and radiographic results. There was no correlation between age at surgery and quality of results. The 5 patients who underwent condyloradial pinning showed early recurrence of dislocation and osteoarthritic remodeling. The three cases of Bado type-3 lesion had early recurrence of dislocation.

DISCUSSION:

Proximal ulnar osteotomy gives good long-term results in Bado type-1 lesions, regardless of age, if performed before 1 year, in the absence of osteoarthritic remodeling. Associated ligamentoplasty does not seem to be useful.

LEVEL OF EVIDENCE:

IV (retrospective).

KEYWORDS:

Children; Monteggia; Radial head dislocation; Ulnar osteotomy

PMID:
25304829
DOI:
10.1016/j.otsr.2014.06.022
[Indexed for MEDLINE]
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