Skip to main content
SpringerLink
Log in

Classificazione, inquadramento diagnostico e trattamento della lesione di Monteggia in età pediatrica

Classification, diagnosis and treatment of Monteggia lesions during childhood

  • Aggiornamenti
  • Published:
LO SCALPELLO-OTODI Educational

Abstract

Monteggia fractures represent the association of a fracture of the proximal ulna and luxation of the radial head. This type of lesion is infrequent and may be misdiagnosed, particularly in paediatric patients. Classification of these injuries is based on the scheme proposed by Bado and later supplemented by other authors to better discriminate doubts and to guide the treatment. The treatment of choice of acute Monteggia lesions in the paediatric age is in most cases conservative, and it involves reduction and immobilisation in a cast. Surgery is mostly reserved for complex cases and for inveterate lesions that represent a high risk for chronic disorders and disabling sequelae; in these cases, the choice of treatment remains controversial. The aim of this article is to describe the anatomical-pathological characteristics, the diagnostic criteria, and the principles of treatment of Monteggia lesions in the paediatric age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

Bibliografia

  1. Monteggia GB (1814) Istituzioni chirurgiche, vol 5. Maspero, Milan

    Google Scholar 

  2. Bado JL (1967) The Monteggia lesion. Clin Orthop Relat Res 50:71–86

    Article  CAS  PubMed  Google Scholar 

  3. Ring D, Jupiter JB, Waters PM (1998) Monteggia fractures in children and adults. J Am Acad Orthop Surg 6(4):215–224

    Article  CAS  PubMed  Google Scholar 

  4. Goh SH (2008) Monteggia fracture-dislocation with bowing of the ulna: a pitfall for the unwary emergency physician. Eur J Emerg Med 15:281–282

    Article  PubMed  Google Scholar 

  5. Dormans JP, Rang M (1990) The problem of Monteggia fracture dislocations in children. Orthop Clin N Am 21:251–256

    CAS  Google Scholar 

  6. Jacquemier M, Dick R, Jouve JL et al. (1990) La lésion de Monteggia. Monographie du GEOP: les fractures des membres chez l’enfant. Sauramps Medical, Montpellier, pp 215–231

    Google Scholar 

  7. Verneret C, Langlais J, Pouliquen JC, Rigault P (1989) Les luxations anciennes post-traumatiques de la tête radiale chez l’enfant. Rev Chir Orthop 74(Suppl 1):S134–S136

    Google Scholar 

  8. Kim HT, Conjares JN, Suh JT, Yoo CI (2002) Chronic radial head dislocation in children, part 1: pathologic changes preventing stable reduction and surgical correction. J Pediatr Orthop 22:583–590

    PubMed  Google Scholar 

  9. Storen G (1959) Traumatic dislocation of the radial head as an isolated lesion in children; report of one case with special regard to roentgen diagnosis. Acta Chir Scand 116:144–147

    CAS  PubMed  Google Scholar 

  10. Kunkel S, Cornwall R, Little K et al. (2011) Limitations of the radiocapitellar line for assessment of pediatric elbow radiographs. J Pediatr Orthop 31(6):628–632

    Article  PubMed  Google Scholar 

  11. Ramirez RN, Ryan DD, Williams J et al. (2014) A line drawn along the radial shaft misses the capitellum in 16% of radiographs of normal elbows. J Pediatr Orthop 34(8):763–767

    Article  PubMed  Google Scholar 

  12. Souder CD, Roocroft JH, Edmonds EW (2017) Significance of the lateral humeral line for evaluating radiocapitellar alignment in children. J Pediatr Orthop 37(3):e150–e155

    Article  PubMed  Google Scholar 

  13. Lincoln TL, Mubarak SJ (1994) “Isolated” traumatic radial-head dislocation. J Pediatr Orthop 14(4):454–457

    Article  CAS  PubMed  Google Scholar 

  14. Kim HT, Conjares JN, Suh JT, Yoo CI (2002) Chronic radial head dislocation in children, part 1: pathologic changes preventing stable reduction and surgical correction. J Pediatr Orthop 22(5):583–590

    PubMed  Google Scholar 

  15. Rehim SA, Maynard MA, Sebastin SJ, Chung KC (2014) Monteggia fracture dislocations: a historical review. J Hand Surg 39(7):1384–1394

    Article  Google Scholar 

  16. Delpont M, Jouve JL, Sales de Gauzy J et al. (2014) Proximal ulnar osteotomy in the treatment of neglected childhood Monteggia lesion. Orthop Traumatol, Surg Res 100(7):803–807

    Article  CAS  Google Scholar 

  17. Letts M, Locht R, Wiens J (1985) Monteggia fracture-dislocations in children. J Bone Jt Surg, Br Vol 67(5):724–727

    Article  CAS  Google Scholar 

  18. Ring D, Waters PM (1996) Operative fixation of Monteggia fractures in children. J Bone Jt Surg 78B:734–739

    Article  Google Scholar 

  19. Wilkins KE (2002) Changes in the management of Monteggia fractures. J Pediatr Orthop 22:548–554

    PubMed  Google Scholar 

  20. de la Garza J (2006) Monteggia fracture-dislocation in children. Rockwood & Wilkins’ fractures in children, 6th edn. Lippincott Williams & Wilkins, Philadelphia, pp 491–527

    Google Scholar 

  21. Armstrong RD, McLaren AC (1987) Biceps tendon blocks reduction of isolated radial head dislocation. Orthop Rev 16:104–108

    CAS  PubMed  Google Scholar 

  22. Hirayama T, Takemitsu Y, Yagihara K, Mikita A (1987) Operation for chronic dislocation of the radial head in children. Reduction by osteotomy of the ulna. J Bone Jt Surg 69B:639–642

    Article  Google Scholar 

  23. Gyr BM, Stevens PM, Smith JT (2004) Chronic Monteggia fractures in children: outcome after treatment with the Bell–Tawse procedure. J Pediatr Orthop, B 13:402–406

    Article  Google Scholar 

  24. Eygendaal D, Hillen RJ (2007) Open reduction and corrective ulnar osteotomy for missed radial head dislocations in children. Strateg Trauma Limb Reconstr 2:31–34

    Article  CAS  Google Scholar 

  25. Bhaskar A (2009) Missed Monteggia fracture in children: is annular ligament reconstruction always required? Indian J Orthop 43:389–395

    Article  PubMed Central  PubMed  Google Scholar 

  26. Fabricant PD, Baldwin KD (2015) Missed pediatric Monteggia fracture: a 63-year follow-up. J Pediatr 167(2):495

    Article  PubMed  Google Scholar 

  27. Kim HT, Park BG, Suh JT, Yoo CI (2002) Chronic radial head dislocation in children, part 2: results of open treatment and factors affecting final outcome. J Pediatr Orthop 22:591–597

    PubMed  Google Scholar 

  28. Bor N (2015) Chronic anterior Monteggia lesions in children: report of 4 cases treated with closed reduction by ulnar osteotomy and external fixation. J Pediatr Orthop 35:7–10

    Article  PubMed  Google Scholar 

  29. Bell Tawse AJ (1965) The treatment of malunited anterior Monteggia fractures in children. J Bone Jt Surg, Br Vol 47-B:718–723

    Article  Google Scholar 

  30. Bouyala JM, Chrestian P, Ramaherison P (1978) L’ostéotomie haute du cubitusdans le traitement de la luxation antérieurerésiduelle après fracture de Monteggia. Chiropr Pediatr 19:201–203

    CAS  Google Scholar 

  31. Di Gennaro GL, Martinelli A, Bettuzzi C et al. (2015) Outcomes after surgical treatment of missed Monteggia fractures in children. Musculoskelet Surg 99(Suppl 1):S75–82

    Article  PubMed  Google Scholar 

  32. Kalamchi A (1986) Monteggia fracture dislocation in children. Late treatment in two cases. J Bone Jt Surg, Am 68:615–619

    Article  CAS  Google Scholar 

  33. Horii E, Nakamura R, Koh S et al. (2002) Surgical treatment for chronic radial head dislocation. J Bone Jt Surg, Am 84-A:1183–1188

    Article  Google Scholar 

  34. Inoue G, Shionoya K (1998) Corrective ulnar osteotomy for malunited anterior Monteggia lesions in children: 12 patients followed for 1–12 years. Acta Orthop Scand 69:73–76

    Article  CAS  PubMed  Google Scholar 

  35. Xu Z, Li Y, Wang Z, Cai H (2017) Open reduction combined with CORA-based osteotomy of the ulna in the treatment of missed Bado type I Monteggia injury: a retrospective study of 5 cases. Medicine (Baltimore) 96(47):e8609

    Article  Google Scholar 

  36. Nakamura K, Hirachi K, Uchiyama S et al. (2009) Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children. J Bone Jt Surg, Am 91(6):1394–1404

    Article  Google Scholar 

  37. Rodriguez-Merchan EC (2005) Pediatric fractures of the forearm. Clin Orthop Relat Res 432:65–72

    Article  Google Scholar 

  38. Song KS, Ramnani K, Bae KC et al. (2012) Indirect reduction of the radial head in children with chronic Monteggia lesions. J Orthop Trauma 26:597–601

    Article  PubMed  Google Scholar 

  39. Lu X, Kun Wang Y, Zhang J et al. (2013) Management of missed Monteggia fractures with ulnar osteotomy, open reduction, and dual-socket external fixation. J Pediatr Orthop 33:398–402

    Article  PubMed  Google Scholar 

  40. Belangero WD, Livani B, Zogaib RK (2007) Treatment of chronic radial head dislocations in children. Int Orthop 31:151–154

    Article  CAS  PubMed  Google Scholar 

  41. Hasler CC, Von Laer L, Hell AK (2005) Open reduction, ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius. J Bone Jt Surg, Br Vol 87-B:88–94

    Article  Google Scholar 

  42. Exner GU (2001) Missed chronic anterior Monteggia lesion. Closed reduction by gradual lengthening and angulation of the ulna. J Bone Jt Surg, Br Vol 83(4):547–550

    Article  CAS  Google Scholar 

  43. Giannicola G, Sacchetti FM, Greco A et al. (2010) Management of complex elbow instability. Musculoskelet Surg 94(Suppl 1):S25–S36

    Article  PubMed  Google Scholar 

  44. Reckling FW (1982) Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). J Bone Jt Surg, Am 64(6):857–863

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Struttura Complessa di Ortopedia e Traumatologia Pediatrica, istituto Ortopedico Rizzoli, Bologna, Italy

    Giovanni Gallone, Giovanni Trisolino, Giovanni Luigi Di Gennaro, Diego Antonioli & Stefano Stilli

Authors
  1. Giovanni Gallone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Trisolino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giovanni Luigi Di Gennaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Diego Antonioli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefano Stilli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giovanni Gallone.

Ethics declarations

Conflitto di interesse

Gli autori Giovanni Gallone, Giovanni Trisolino, Giovanni Luigi Di Gennaro, Diego Antonioli e Stefano Stilli dichiarano di non avere alcun conflitto di interesse.

Consenso informato e conformità agli standard etici

Tutte le procedure descritte nello studio e che hanno coinvolto esseri umani sono state attuate in conformità alle norme etiche stabilite dalla dichiarazione di Helsinki del 1975 e successive modifiche. Il consenso informato è stato ottenuto da tutti i pazienti inclusi nello studio.

Human and Animal Rights

L’articolo non contiene alcuno studio eseguito su esseri umani e su animali da parte degli autori.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gallone, G., Trisolino, G., Di Gennaro, G.L. et al. Classificazione, inquadramento diagnostico e trattamento della lesione di Monteggia in età pediatrica. LO SCALPELLO 32, 262–270 (2018). https://doi.org/10.1007/s11639-018-00294-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11639-018-00294-9

Search

Navigation