Abe Muneaki, Kumano Hozumi, Kinoshita Akihiko, Hirofuji Shinji
Department of Orthopedic Surgery, Shiroyama Hospital, Habikino, Japan (Dr. Abe, Dr. Kumano, and Dr. Kinoshita), and the Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan (Dr. Hirofuji).
J Am Acad Orthop Surg Glob Res Rev. 2018 May 3;2(5):e035. doi: 10.5435/JAAOSGlobal-D-17-00035. eCollection 2018 May.
In pediatric patients with Monteggia lesions, the radial head can be reduced manually when displacement of the fractured ulna is corrected. Occasionally, however, a dislocated radial head could not be reduced manually even when the length and/or angulation of the fractured ulna had been corrected. We can find such cases in the literature, but those are single case reports. We encountered 17 cases of irreducible dislocation of the radial head in pediatric Monteggia lesions during the past 43 years. The purposes of this study were to identify the characteristics of our cases and to discuss the factors that inhibited reduction of the radial head.
Of 109 children treated for Monteggia lesions between 1972 and 2015, we encountered 17 cases of irreducible dislocation of the radial head. The patients' ages averaged 7.1 years, ranging from 2.6 to 12.1 years. Directions of the radial head dislocation were anterior in five cases, anteromedial in four, lateral in one, and anterolateral in seven. Most of the patients were referred to us from local orthopaedic clinics because of irreducibility of the radial head. We reduced the radial head surgically and confirmed the causes of irreducibility.
In 10 of the 17 cases, the problem was identified as pseudoreduction. In those cases, the radial head was reduced in a supination position but redisplaced in a pronation position. Causes of irreducibility were traced to the annular ligament in 15 cases, biceps tendon in 1, and posterior interosseous nerve in 1.
In cases of pediatric Monteggia lesions, we should pay attention to patients in whom the dislocated radial head is not reduced after closed reduction. The most frequent cause of hindered reduction was interposition of the annular ligament in the radiocapitellar joint. Here, the radial head seems to be reduced in the supination position but becomes redisplaced in the pronation position. After closed reduction, it is important to confirm whether the radial head is stable in both pronation and supination positions.
Diagnostic level IV.
在儿童孟氏骨折患者中，当骨折的尺骨移位得到纠正时，桡骨头可手动复位。然而，偶尔即使骨折尺骨的长度和/或成角已得到纠正，脱位的桡骨头也无法手动复位。我们在文献中能找到此类病例，但都是个案报道。在过去43年里，我们遇到了17例儿童孟氏骨折中桡骨头不可复位脱位的病例。本研究的目的是确定我们这些病例的特点，并探讨阻碍桡骨头复位的因素。
在1972年至2015年间接受治疗的109例孟氏骨折患儿中，我们遇到了17例桡骨头不可复位脱位的病例。患者平均年龄7.1岁，范围在2.6岁至12.1岁之间。桡骨头脱位方向为前方5例，前内侧4例，外侧1例，前外侧7例。大多数患者因桡骨头不可复位而从当地骨科诊所转诊至我们这里。我们通过手术复位桡骨头并确认不可复位的原因。
17例中有10例问题被确定为假复位。在这些病例中，桡骨头在旋后位复位，但在旋前位再次移位。不可复位的原因在15例中可追溯到环状韧带，1例为肱二头肌腱，1例为骨间后神经。
在儿童孟氏骨折病例中，我们应关注闭合复位后脱位的桡骨头未复位的患者。复位受阻最常见的原因是环状韧带嵌入桡骨头关节。在此情况下，桡骨头似乎在旋后位复位，但在旋前位再次移位。闭合复位后，确认桡骨头在旋前位和旋后位是否稳定很重要。
诊断性IV级。
