Implementing the three step method in the acute phase helps avoid catastrophic consequences on joint range of motion in the chronic stage.Īcute Approach Chronic Fixation Fracture Management Monteggia Pediatric Rehabilitation Stability.Ĭopyright © 2021 The Authors. The Three Step Method allows for primary definitive treatment of these lesions with low complication rates and good range of motion result. Excellent range of motion was observed in all three groups. By managing the patients with the Three Step Method retaining the reduction was successful in all but one of our acute cases in the study period. No nerve or tendon injuries or infections were observed in these cases. 10 patients were treated with reduction+casting, 10 with reduction+ESIN and 3 with reduction+plating.Ģ1 patients were available for long-term follow-up. The main lesions are as follows: (1) Ulnar fracture, (2) Radio-humeral dislocation, (3) Ulno-humeral dislocation, (4) Proximal radio-ulnar dislocation, (5) Radial fracture and (6) Distal radio-ulnar joint/inter-osseus membrane lesion. In the 23 acute cases, the selected procedure-reduction+casting/reduction+ESIN/reduction+plating - was performed within 2 to 16 h of arrival. In our Department we aim for definitive treatment of fracture-dislocations in children within the acute setting. Open reduction and intramedullary nailing with ESIN, or 3. Closed reduction under image intensifier followed by immobilization in over the elbow cast, 2. Retrospective analysis of 23 patients treated for this type of injury at our Department over a period of 6 years was performed. The goal of this paper is to describe our three-step approach to the treatment of acute Monteggia lesions based on the stability and radiological appearance of the fracture dislocation, to give an overview of possible pitfalls and clinical and radiological signs that aid the diagnostic process. Failure to make an early correct diagnosis may have catastrophic consequences on joint range of motion in the chronic stage. There are circumstances, which may make early correct diagnosis difficult. The literature places the occurrence of paediatric Monteggia lesions between 1.5% and 3% of all childhood elbow injuries.
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