Surgery for monteggia fracture9/6/2023 proposed a pediatric classification subdividing Bado type I according to the fracture of the ulnar bone (i.e., plastic deformity, green stick, and complete fractures) (Fig. According to the subsequent experience in children, a Monteggia lesion can be easily disregarded if there is a subperiosteal lesion with ulnar deformity or a green stick fracture with radial head dislocation. This system, based on the direction of radial bone head displacement and angle of ulnar bone fracture, is extensively presented in clinical practice, and publications focused on this problem. Thus, in 1967, Monteggia fractures were additionally classified by Jose Luis Bado four main types and seven equivalent injuries were identified (six Monteggia equivalents to type I and one equivalent to type II) (Fig. With the accumulation of clinical cases and their analysis, clarifying the pathological anatomy of the damage and highlighting some patterns became necessary. According to most experts, the term “neglected or chronic Monteggia injury” should be used when the injury is more than 2–4 weeks old. Consequently, a neglected Monteggia lesion was formed. The dislocation of the radial head with an obvious fracture of the ulnar bone is often left out of consideration with potentially serious functional consequences. It appears surprising however, even after two centuries, orthopedists, being formally familiarized with the damage described by our predecessor, repeat Monteggia’s diagnostic error. Monteggia presented the history of his mistake, namely, anterior radial bone dislocation unnoticed in time. In 1814, a pathologist and surgeon from Milan, Giovanni Battista Monteggia, first described a fracture of the diaphyseal ulna with radial bone head dislocation. Surgical treatment is the main method of treating children with this injury, in which the restoration of the ulnar anatomy and the ratios in the brachial and proximal radiocarpal joints are the most important, providing a more physiological development of the segment with the growth of the child. The most common complications were associated with the deterioration of the functional status after surgery.ĬONCLUSIONS : Accurate diagnosis of injury and early correction of existing disorders is the key to reducing the frequency of missed Monteggia fractures. Bone osteosynthesis and external fixation apparatus were the most widely used stabilization methods in 350 (67.8%) and 149 (28.9%), respectively. The second most frequent application was the above-described approach, but without manipulations on the annular ligament ( n = 273, 30.9%). Thus, open reduction of the radial head in combination with the restoration or reconstruction of the annular ligament and ulnar osteotomy is one of the most common methods ( n = 482, 54.6%). The average interval from injury to the surgical treatment of missed Monteggia fracture was 15.3 months, and 883 clinical cases presented in sources with known treatment techniques were analyzed. RESULTS : The average age of the children was 8.4 years. The main characteristics revealing the problem were identified, divided into four semantic groups, according to which the literature was analyzed: initial data on the condition of patients at the time of seeking medical help, status before and after treatment, and treatment methods. Moreover, 46 sources were selected based on the criteria. MATERIALS AND METHODS : A literature search was conducted in the Cochrane Database, Science Direct, Google Scholar, PubMed, and eLibrary information bases, and the search depth was 10 years. Unsatisfactory results of the treatment of this pathology have prompted several researchers to search for an optimal treatment strategy.ĪIM : This study aimed to conduct a systematic review of literature data on missed Monteggia fractures and dislocations in children by studying the main therapeutic and tactical approaches to this problem. BACKGROUNG : A situation in which despite an obvious ulnar fracture, radial head dislocation is not diagnosed, resulting in a missed Monteggia fracture is not uncommon.
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