Application of annular ligament reposition and repair via Henry’s approach for Monteggia fracture in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YUE Junyi , MU Mingzhang , SUN Hongmei , JIANG Xiaoyan ,  CHEN Xu

Department of Orthopedics, Yantaishan Hospital, Yantai Shandong, 264000, P.R.China;

Corresponding author：

CHEN Xu, Email: chenxu19630@126.com

Keywords：

Monteggia fracture; Henry’s approach; annular ligament; reposition; repair; child

DOI：

10.7507/1002-1892.202012106

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Objective To explore the effectiveness of annular ligament reposition and repair via Henry’s approach for Monteggia fracture in children.Methods A clinical data of 21 children with Monteggia fractures was retrospectively analysed, who underwent open reduction of the radial head and annular ligament reposition and repair via Henry’s approach between May 2015 and July 2019. There were 11 boys and 10 girls with an average age of 8 years and 1 month (range, 4 years and 5 months to 14 years and 4 months). The fracture was caused by falling in 17 cases and by falling from height in 4 cases. There were 16 fresh fractures and 5 old fractures. The Monteggia fractures were rated as Bado typeⅠin 14 cases and Bado type Ⅲ in 7 cases. Preoperative MRI examination and intraoperative observation confirmed that the annular ligament was intact. After operation, the fracture healing, elbow range of motion (ROM), and complications were recorded, and the effectiveness was evaluated according to the Mackay’s function scoring system.Results The incisions healed by first intention after operation, and there was no complication such as radial nerve injury. All children were followed up 12-25 months, with an average of 15 months. No dislocation or subluxation of the radial head occurred after operation. At last follow-up, the ROM of elbow flexion and extension of the children with old fractures increased from (92.6±11.2)° before operation to (123.6±11.6)°, and the ROM of forearm rotation from (96.8±11.8)° to (129.8±5.9)°; the differences between pre- and post-operation were significant (t=7.672, P=0.002; t=9.487, P=0.001); the ROM of elbow flexion and extension of the children with fresh fractures was 139°-156° (mean, 145°); the ROM of forearm rotation was 158°-168° (mean, 162°). According to Mackay’s criteria, 17 cases were excellent and 4 cases were good, with an excellent and good rate of 100%. X-ray film examination showed no nonunion, heterotopic ossification, or loosening of internal fixation after operation. The ulnar fracture and the ulnar osteotomy healed in all cases.Conclusion The annular ligament in Monteggia fractures in children is intact. Compared with the reconstruction of the annular ligament, the reposition and repair of the annular ligament via Henry’s approach is closer to the original anatomical state of the annular ligament and has the advantages of less trauma and fewer complications.

Citation： YUE Junyi, MU Mingzhang, SUN Hongmei, JIANG Xiaoyan, CHEN Xu. Application of annular ligament reposition and repair via Henry’s approach for Monteggia fracture in children. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(5): 562-566. doi: 10.7507/1002-1892.202012106 Copy

1.	Canton G, Hoxhaj B, Fattori R, et al. Annular ligament reconstruction in chronic Monteggia fracture-dislocations in the adult population: indications and surgical technique. Musculoskelet Surg, 2018, 102(Suppl 1): 93-102.
2.	Hackl M, Wegmann K, Ries C, et al. Annular ligament reconstruction with the superficial head of the brachialis: surgical technique and biomechanical evaluation. Surg Radiol Anat, 2017, 39(6): 585-591.
3.	Bell Tawse AJ. The treatment of malunited anterior Monteggia fractures in children. J Bone Joint Surg (Br), 1965, 47(4): 718-723.
4.	Wang MN, Chang WN. Chronic posttraumatic anterior dislocation of the radial head in children: thirteen cases treated by open reduction, ulnar osteotomy, and annular ligament reconstruction through a Boyd incision. J Orthop Trauma, 2006, 20(1): 1-5.
5.	Lloyd-Roberts GC, Bucknill TM. Anterior dislocation of the radial head in children: aetiology, natural history and management. J Bone Joint Surg (Br), 1977, 59-B(4): 402-407.
6.	Gyr BM, Stevens PM, Smith JT. Chronic Monteggia fractures in children: outcome after treatment with the Bell-Tawse procedure. J Pediatr Orthop B, 2004, 13(6): 402-406.
7.	Chen HY, Wu KW, Dong ZR, et al. The treatment of chronic radial head dislocation in Monteggia fracture without annular ligament reconstruction. Int Orthop, 2018, 42(9): 2165-2172.
8.	Zheng ET, Waters PM, Vuillermin CB, et al. Surgical reconstruction of missed Monteggia Lesions in children. J Pediatr Orthop, 2020, 40(10): e916-e921.
9.	Nakamura K, Hirachi K, Uchiyama S, et al. Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children. J Bone Joint Surg (Am), 2009, 91(6): 1394-1404.
10.	Zhou W, Li L, Mu M. Treatment of missed Monteggia fracture with intact annular ligament after an interval of 9 years: a case report and literature review. J Int Med Res, 2020, 48(8): 300060520949079. doi: 10.1177/0300060520949079.
11.	张同庆, 慕明章, 唐伟, 等. Henry入路前关节囊横切松解下移选择性后关节囊纵切桡骨头套入治疗儿童陈旧性孟氏骨折. 中华小儿外科杂志, 2020, 41(8): 739-743.
12.	张同庆, 慕明章, 唐伟, 等. 部分肱二头肌肌腱转位修复环状韧带治疗儿童陈旧性孟氏骨折. 中华小儿外科杂志, 2018, 39(11): 821-824.
13.	Mackay D, Wood L, Rangan A. The treatment of isolated ulnar fractures in adults: a systematic review. Injury, 2000, 31(8): 565-570.
14.	Hetthéssy JR, Sebök B, Vadász A, et al. The three step approach to the management of acute pediatric Monteggia lesions. Injury, 2021, 52 Suppl 1: S57-S62.
15.	Hui JH, Sulaiman AR, Lee HC, et al. Open reduction and annular ligament reconstruction with fascia of the forearm in chronic monteggia lesions in children. J Pediatr Orthop, 2005, 25(4): 501-506.
16.	Reckling FW. Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). J Bone Joint Surg (Am), 1982, 64(6): 857-863.
17.	Husarik DB, Saupe N, Pfirrmann CW, et al. Ligaments and plicae of the elbow: normal MR imaging variability in 60 asymptomatic subjects. Radiology, 2010, 257(1): 185-194.
18.	慕明章, 曲建香, 马全玉, 等. 儿童孟氏骨折环状韧带损伤病理及机制的探讨. 中华小儿外科杂志, 2005, 26(9): 502-503.
19.	Lu X, Yan G, Wang Y, et al. Repositioning of the annular ligament in the management of missed monteggia fracture. J Pediatr Orthop, 2017, 37(1): 20-22.
20.	Camp CL, Fu M, Jahandar H, et al. The lateral collateral ligament complex of the elbow: quantitative anatomic analysis of the lateral ulnar collateral, radial collateral, and annular ligaments. J Shoulder Elbow Surg, 2019, 28(4): 665-670.

1. Canton G, Hoxhaj B, Fattori R, et al. Annular ligament reconstruction in chronic Monteggia fracture-dislocations in the adult population: indications and surgical technique. Musculoskelet Surg, 2018, 102(Suppl 1): 93-102.
2. Hackl M, Wegmann K, Ries C, et al. Annular ligament reconstruction with the superficial head of the brachialis: surgical technique and biomechanical evaluation. Surg Radiol Anat, 2017, 39(6): 585-591.
3. Bell Tawse AJ. The treatment of malunited anterior Monteggia fractures in children. J Bone Joint Surg (Br), 1965, 47(4): 718-723.
4. Wang MN, Chang WN. Chronic posttraumatic anterior dislocation of the radial head in children: thirteen cases treated by open reduction, ulnar osteotomy, and annular ligament reconstruction through a Boyd incision. J Orthop Trauma, 2006, 20(1): 1-5.
5. Lloyd-Roberts GC, Bucknill TM. Anterior dislocation of the radial head in children: aetiology, natural history and management. J Bone Joint Surg (Br), 1977, 59-B(4): 402-407.
6. Gyr BM, Stevens PM, Smith JT. Chronic Monteggia fractures in children: outcome after treatment with the Bell-Tawse procedure. J Pediatr Orthop B, 2004, 13(6): 402-406.
7. Chen HY, Wu KW, Dong ZR, et al. The treatment of chronic radial head dislocation in Monteggia fracture without annular ligament reconstruction. Int Orthop, 2018, 42(9): 2165-2172.
8. Zheng ET, Waters PM, Vuillermin CB, et al. Surgical reconstruction of missed Monteggia Lesions in children. J Pediatr Orthop, 2020, 40(10): e916-e921.
9. Nakamura K, Hirachi K, Uchiyama S, et al. Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children. J Bone Joint Surg (Am), 2009, 91(6): 1394-1404.
10. Zhou W, Li L, Mu M. Treatment of missed Monteggia fracture with intact annular ligament after an interval of 9 years: a case report and literature review. J Int Med Res, 2020, 48(8): 300060520949079. doi: 10.1177/0300060520949079.
11. 张同庆, 慕明章, 唐伟, 等. Henry入路前关节囊横切松解下移选择性后关节囊纵切桡骨头套入治疗儿童陈旧性孟氏骨折. 中华小儿外科杂志, 2020, 41(8): 739-743.
12. 张同庆, 慕明章, 唐伟, 等. 部分肱二头肌肌腱转位修复环状韧带治疗儿童陈旧性孟氏骨折. 中华小儿外科杂志, 2018, 39(11): 821-824.
13. Mackay D, Wood L, Rangan A. The treatment of isolated ulnar fractures in adults: a systematic review. Injury, 2000, 31(8): 565-570.
14. Hetthéssy JR, Sebök B, Vadász A, et al. The three step approach to the management of acute pediatric Monteggia lesions. Injury, 2021, 52 Suppl 1: S57-S62.
15. Hui JH, Sulaiman AR, Lee HC, et al. Open reduction and annular ligament reconstruction with fascia of the forearm in chronic monteggia lesions in children. J Pediatr Orthop, 2005, 25(4): 501-506.
16. Reckling FW. Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). J Bone Joint Surg (Am), 1982, 64(6): 857-863.
17. Husarik DB, Saupe N, Pfirrmann CW, et al. Ligaments and plicae of the elbow: normal MR imaging variability in 60 asymptomatic subjects. Radiology, 2010, 257(1): 185-194.
18. 慕明章, 曲建香, 马全玉, 等. 儿童孟氏骨折环状韧带损伤病理及机制的探讨. 中华小儿外科杂志, 2005, 26(9): 502-503.
19. Lu X, Yan G, Wang Y, et al. Repositioning of the annular ligament in the management of missed monteggia fracture. J Pediatr Orthop, 2017, 37(1): 20-22.
20. Camp CL, Fu M, Jahandar H, et al. The lateral collateral ligament complex of the elbow: quantitative anatomic analysis of the lateral ulnar collateral, radial collateral, and annular ligaments. J Shoulder Elbow Surg, 2019, 28(4): 665-670.

Chinese Journal of Reparative and Reconstructive Surgery

Application of annular ligament reposition and repair via Henry’s approach for Monteggia fracture in children

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