Stitgen Andrea, McCarthy James J, Nemeth Blaise A, Garrels Kathryn, Noonan Kenneth J
Department of Orthopaedics, University of Wisconsin, Madison, Wisconsin, USA.
Orthopedics. 2012 Mar 7;35(3):e434-7. doi: 10.3928/01477447-20120222-35.
Monteggia fractures are rare but commonly discussed lesions, with increasing complications due to late diagnosis. This article describes a case of a Monteggia fracture with delayed dislocation of the radial head. Previous radiographs of a 2-year 8-month-old boy show complete fracture of the distal ulna, with no radial head dislocation. The radial head remained well positioned after 4 weeks. Seven years later, he sustained another arm injury. He was diagnosed with a hematoma but was later believed to have nursemaid's elbow. He presented to our institution 5 weeks after the injury, and the radial head was found to be chronically dislocated, indicating a displacement occurring sometime during the past 7 years. After failing conservative treatment, the patient underwent surgical repair. The annular ligament was reconstructed using a harvested triceps fascia band, and an ulnar osteotomy was performed. A review of the literature found few reports of delayed Monteggia fractures, which accounted the delayed dislocations to ulnar angulation. However, our patient showed minimal ulnar angular deformity. We propose that the initial fracture disrupted the annular ligament and the radial head spontaneously relocated prior to being seen, which put the radial head at risk for later dislocation. We present an alternative hypothesis of dislocation after fracture healing and report the longest known period of delay between fracture and dislocation.
孟氏骨折虽罕见，但却是常被讨论的损伤，因诊断延迟会导致并发症增多。本文描述了一例伴有桡骨头延迟脱位的孟氏骨折病例。一名2岁8个月男孩之前的X线片显示尺骨远端完全骨折，无桡骨头脱位。4周后桡骨头位置良好。7年后，他再次手臂受伤。最初诊断为血肿，但后来被认为是牵拉肘。受伤5周后他来到我们机构，发现桡骨头慢性脱位，表明在过去7年中的某个时间发生了移位。保守治疗失败后，患者接受了手术修复。使用采集的肱三头肌筋膜带重建环状韧带，并进行了尺骨截骨术。文献回顾发现关于延迟性孟氏骨折的报道很少，将延迟脱位归因于尺骨成角。然而，我们的患者尺骨角畸形极小。我们提出最初的骨折破坏了环状韧带，桡骨头在被发现之前自行复位，这使桡骨头有 later dislocation的风险。我们提出了骨折愈合后脱位的另一种假说，并报告了骨折与脱位之间已知最长的延迟时间。 （注：原文中“later dislocation”表述有误，推测可能是“late dislocation”，翻译时按推测修正为“晚期脱位”）
