TREATMENT OF OLD RADIAL HEAD DISLOCATION IN CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HETaozhen ¹ , SUNXiaoyan ² , JIANGJun ¹ , PENGMingxing ¹ , MAHuixu ¹ , YANGLixun ¹ , XIAOBin ¹ ,  LIUMin ¹

1. Department of Pediatric Surgery, Chengdu Sichuan, 610041, P. R. China;
2. Health Management Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

LIUMin, Email: huaxilm@163.com

Keywords：

Old radial head dislocation; Monteggia fracture; Internal fixation; Children

DOI：

10.7507/1002-1892.20140204

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Objective To evaluate the short-term effectiveness of transarticular fixation of humeroradial joint by Kirschner wire (or combined with proximal ulnar osteotomy) for old radial head dislocation after open reduction of the radial head in children. Methods A retrospective analysis was made on the clinical data of 25 children with old radial head dislocation between January 2008 and December 2010.There were 18 boys and 7 girls,aged 2 years and 5 months to 9 years and 5 months (mean,5 years and 11 months).The left side was involved in 13 cases,and the right side in 12 cases.The interval of injury and operation was 3 weeks to 30 months (median,14 months).The main presentations were abnormal mass in the anterior elbow,motion limitation of forearm pronation,and dorsiflexion inability of wrist and thumb.Three patients had radial nerve lesion.In 23 patients with simple radial head dislocation,transarticular fixation of humeroradial joint by Kirschner wire was used after open reduction of the radial head; in 2 patients with Monteggia fracture,transarticular fixation by Kirschner wire and additional proximal ulnar osteostomy were used. Results A primary healing of incision was obtained,without complication of infection,joint stiffness,or radial head necrosis.Twenty-four patients were followed up 29-58 months (mean,44.3 months); one case had re-dislocation,failed to be followed up at 2.5 months postoperatively.In 3 patients with radial nerve injury,neural function recovery was obtained in 2 cases,and no improvement was observed in 1 case.Twenty-three had no pain,no deformity,and no motion limitation of elbow and forearm except 1 patient with no improvement of neural function.The mean range of montion (ROM) of elbow flexion was 134° (range,125-140°),and the mean ROM of extension was -4° (range,-8-0°); the mean ROM of forearm pronation was 74° (range,65-80°),and the ROM of supination was 90°.According to Mackay's criteria,the results were excellent in 22 cases,good in 1 case,and poor in 1 case at 2 years after operation. Conclusion The transarticular fixation of humeroradial joint by Kirschner wire (or combined with proximal ulnar osteotomy) is a feasible and effective method to treat old radial head dislocation in children based on a short-term follow-up.

Citation： HETaozhen, SUNXiaoyan, JIANGJun, PENGMingxing, MAHuixu, YANGLixun, XIAOBin, LIUMin. TREATMENT OF OLD RADIAL HEAD DISLOCATION IN CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(8): 929-932. doi: 10.7507/1002-1892.20140204 Copy

1.	Tompkins DG.The anterior Monteggia fracture:observations on etiology and treatment.J Bone Joint Surg (Am),1971,53(6):1109-1114.
2.	Bado JL.The Monteggia lesion.Clin Orthop Relat Res,1967,(50):71-86.
3.	Mackay I,Fiezgerald B,Miller JH.Silastic replacement of the head of the radius in trauma.J Bone Joint Surg (Br),1979,61-B(4):494-497.
4.	Hasler CC,Von Laer L,Hell AK.Open reduction,ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius.J Bone Joint Surg (Br),2005,87(1):88-94.
5.	L?dermann A,Ceroni D,Lefèvre Y,et al.Surgical treatment of missed Monteggia lesions in children.J Child Orthop,2007,1(4):237-242.
6.	Belangero WD,Livani B,Zogaib RK.Treatment of chronic radial head dislocations in children.Int Orthop,2007,31(2):151-154.
7.	朱玉奎,劉振英,張友.兒童陳舊性孟氏骨折的治療.中華骨科雜志,1992,12(6):422-424.
8.	Bilen FE,Kocao?lu M,Eralp L.Indirect reduction of the radial head using an external fixator to treat chronic radial head dislocations.Acta Orthop Traumatol Turc,2010,44(1):14-19.
9.	Rahbek O,Deutch SR,Kold S,et al.Long-term outcome after ulnar osteotomy for missed Monteggia fracture dislocation in children.J Child Orthop,2011,5(6):449-457.
10.	Song KS,Ramnani K,Bae KC,et al.Indirect reduction of the radial head in children with chronic Monteggia lesions.J Orthop Trauma,2012,26(10):597-601.
11.	Lu X,Kun Wang Y,Zhang J,et al.Management of missed Monteggia fractures with ulnar osteotomy,open reduction,and dual-socket external fixation.J Pediatr Orthop,2013,33(4):398-402.
12.	陳志文,丁真奇,林斌,等.尺骨截骨鋼板內固定治療兒童陳舊性橈骨頭前脫位.中國骨傷,2011,24(7):603-605.
13.	胡健,邱維勝,胡學富.尺骨截骨治療兒童陳舊性孟氏骨折.臨床骨科雜志,2008,11(2):163-165.
14.	曾裴,楊建平,任秀智,等.兒童陳舊性孟氏骨折的手術治療.中華骨科雜志,2012,32(5):457-461.
15.	劉威,陳海龍,張志勇,等.伴嚴重畸形的小兒陳舊性孟氏骨折修復重建.中國修復重建外科雜志,2008,22(8):1012-1013.
16.	黃金承,連鴻凱,白玉,等.尺骨截骨加克氏針固定肱橈關節治療兒童陳舊性孟氏骨折.臨床小兒外科雜志,2013,12(3):178-180,218.
17.	宋舸,陳丹,馬曉春,等.兒童陳舊性孟氏骨折合并橈神經深支損傷手術療效分析.中華小兒外科雜志,2002,23(4):334-336.
18.	唐偉,慕明章,譚江威,等.關節囊松解被卡環狀韌帶下移治療兒童陳舊性孟氏骨折.中華小兒外科雜志,2011,32(9):682-685.
19.	孫客,唐盛平,吳德超,等.兒童陳舊性Monteggia骨折的治療.臨床小兒外科雜志,2011,10(3):174-175.
20.	符廣敏,曹雷,李云鵬.兒童陳舊性橈骨頭脫位合并橈神經損傷的治療分析(附26例報告).中國矯形外科雜志,2006,14(12):949-950.

1. Tompkins DG.The anterior Monteggia fracture:observations on etiology and treatment.J Bone Joint Surg (Am),1971,53(6):1109-1114.
2. Bado JL.The Monteggia lesion.Clin Orthop Relat Res,1967,(50):71-86.
3. Mackay I,Fiezgerald B,Miller JH.Silastic replacement of the head of the radius in trauma.J Bone Joint Surg (Br),1979,61-B(4):494-497.
4. Hasler CC,Von Laer L,Hell AK.Open reduction,ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius.J Bone Joint Surg (Br),2005,87(1):88-94.
5. L?dermann A,Ceroni D,Lefèvre Y,et al.Surgical treatment of missed Monteggia lesions in children.J Child Orthop,2007,1(4):237-242.
6. Belangero WD,Livani B,Zogaib RK.Treatment of chronic radial head dislocations in children.Int Orthop,2007,31(2):151-154.
7. 朱玉奎,劉振英,張友.兒童陳舊性孟氏骨折的治療.中華骨科雜志,1992,12(6):422-424.
8. Bilen FE,Kocao?lu M,Eralp L.Indirect reduction of the radial head using an external fixator to treat chronic radial head dislocations.Acta Orthop Traumatol Turc,2010,44(1):14-19.
9. Rahbek O,Deutch SR,Kold S,et al.Long-term outcome after ulnar osteotomy for missed Monteggia fracture dislocation in children.J Child Orthop,2011,5(6):449-457.
10. Song KS,Ramnani K,Bae KC,et al.Indirect reduction of the radial head in children with chronic Monteggia lesions.J Orthop Trauma,2012,26(10):597-601.
11. Lu X,Kun Wang Y,Zhang J,et al.Management of missed Monteggia fractures with ulnar osteotomy,open reduction,and dual-socket external fixation.J Pediatr Orthop,2013,33(4):398-402.
12. 陳志文,丁真奇,林斌,等.尺骨截骨鋼板內固定治療兒童陳舊性橈骨頭前脫位.中國骨傷,2011,24(7):603-605.
13. 胡健,邱維勝,胡學富.尺骨截骨治療兒童陳舊性孟氏骨折.臨床骨科雜志,2008,11(2):163-165.
14. 曾裴,楊建平,任秀智,等.兒童陳舊性孟氏骨折的手術治療.中華骨科雜志,2012,32(5):457-461.
15. 劉威,陳海龍,張志勇,等.伴嚴重畸形的小兒陳舊性孟氏骨折修復重建.中國修復重建外科雜志,2008,22(8):1012-1013.
16. 黃金承,連鴻凱,白玉,等.尺骨截骨加克氏針固定肱橈關節治療兒童陳舊性孟氏骨折.臨床小兒外科雜志,2013,12(3):178-180,218.
17. 宋舸,陳丹,馬曉春,等.兒童陳舊性孟氏骨折合并橈神經深支損傷手術療效分析.中華小兒外科雜志,2002,23(4):334-336.
18. 唐偉,慕明章,譚江威,等.關節囊松解被卡環狀韌帶下移治療兒童陳舊性孟氏骨折.中華小兒外科雜志,2011,32(9):682-685.
19. 孫客,唐盛平,吳德超,等.兒童陳舊性Monteggia骨折的治療.臨床小兒外科雜志,2011,10(3):174-175.
20. 符廣敏,曹雷,李云鵬.兒童陳舊性橈骨頭脫位合并橈神經損傷的治療分析(附26例報告).中國矯形外科雜志,2006,14(12):949-950.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF OLD RADIAL HEAD DISLOCATION IN CHILDREN

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