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.	Lädermann 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,刘振英,张友.儿童陈旧性孟氏骨折的治疗.中华骨科杂志,1992,12(6):422-424.
8.	Bilen FE,Kocaoğlu 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.	陈志文,丁真奇,林斌,等.尺骨截骨钢板内固定治疗儿童陈旧性桡骨头前脱位.中国骨伤,2011,24(7):603-605.
13.	胡健,邱维胜,胡学富.尺骨截骨治疗儿童陈旧性孟氏骨折.临床骨科杂志,2008,11(2):163-165.
14.	曾裴,杨建平,任秀智,等.儿童陈旧性孟氏骨折的手术治疗.中华骨科杂志,2012,32(5):457-461.
15.	刘威,陈海龙,张志勇,等.伴严重畸形的小儿陈旧性孟氏骨折修复重建.中国修复重建外科杂志,2008,22(8):1012-1013.
16.	黄金承,连鸿凯,白玉,等.尺骨截骨加克氏针固定肱桡关节治疗儿童陈旧性孟氏骨折.临床小儿外科杂志,2013,12(3):178-180,218.
17.	宋舸,陈丹,马晓春,等.儿童陈旧性孟氏骨折合并桡神经深支损伤手术疗效分析.中华小儿外科杂志,2002,23(4):334-336.
18.	唐伟,慕明章,谭江威,等.关节囊松解被卡环状韧带下移治疗儿童陈旧性孟氏骨折.中华小儿外科杂志,2011,32(9):682-685.
19.	孙客,唐盛平,吴德超,等.儿童陈旧性Monteggia骨折的治疗.临床小儿外科杂志,2011,10(3):174-175.
20.	符广敏,曹雷,李云鹏.儿童陈旧性桡骨头脱位合并桡神经损伤的治疗分析(附26例报告).中国矫形外科杂志,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. Lädermann 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,刘振英,张友.儿童陈旧性孟氏骨折的治疗.中华骨科杂志,1992,12(6):422-424.
8. Bilen FE,Kocaoğlu 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. 陈志文,丁真奇,林斌,等.尺骨截骨钢板内固定治疗儿童陈旧性桡骨头前脱位.中国骨伤,2011,24(7):603-605.
13. 胡健,邱维胜,胡学富.尺骨截骨治疗儿童陈旧性孟氏骨折.临床骨科杂志,2008,11(2):163-165.
14. 曾裴,杨建平,任秀智,等.儿童陈旧性孟氏骨折的手术治疗.中华骨科杂志,2012,32(5):457-461.
15. 刘威,陈海龙,张志勇,等.伴严重畸形的小儿陈旧性孟氏骨折修复重建.中国修复重建外科杂志,2008,22(8):1012-1013.
16. 黄金承,连鸿凯,白玉,等.尺骨截骨加克氏针固定肱桡关节治疗儿童陈旧性孟氏骨折.临床小儿外科杂志,2013,12(3):178-180,218.
17. 宋舸,陈丹,马晓春,等.儿童陈旧性孟氏骨折合并桡神经深支损伤手术疗效分析.中华小儿外科杂志,2002,23(4):334-336.
18. 唐伟,慕明章,谭江威,等.关节囊松解被卡环状韧带下移治疗儿童陈旧性孟氏骨折.中华小儿外科杂志,2011,32(9):682-685.
19. 孙客,唐盛平,吴德超,等.儿童陈旧性Monteggia骨折的治疗.临床小儿外科杂志,2011,10(3):174-175.
20. 符广敏,曹雷,李云鹏.儿童陈旧性桡骨头脱位合并桡神经损伤的治疗分析(附26例报告).中国矫形外科杂志,2006,14(12):949-950.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF OLD RADIAL HEAD DISLOCATION IN CHILDREN

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