Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Results of surgical treatment for chronic Monteggia\u27s lesions in 16 children were retrospectively analyzed. The mean age at the time of reconstructive surgery was 7 years and 8 months. Using Bado\u27s classification, there were 12 type I, 3 type III lesions, and 1 type IV lesion. In 11 cases, operative procedures consisted of a combination of corrective ulnar osteotomy and open reduction of radial head. Corrective ulnar osteotomy alone was required in 2 cases. Another two cases required a combination of corrective osteotomy of both radial and ulnar shafts. Annular ligament reconstruction had to be performed in only 1 case initially submitted to open reduction of radial head. The patients were examined at 9 years and 6 months of the initial reconstructive procedure on an average. Using the scale proposed by Morrey, there were 9 good, 4 satisfactory, and 3 poor results. Eleven complications were recorded including 2 radial nerve lesions, 2 nonunions at the site of ulnar osteotomy, 5 redislocations and 1 subluxation, and 1 ulnar fracture below the site of osteotomy. Seven of 11 patients with complications underwent repeat operative procedures. These seven patients included both children previously submitted to combined osteotomies of both the ulna and radius as well as both children who had undergone corrective ulnar osteotomy alone. Thus, a very high rate of complications was recorded in our series of patients undergoing operative treatment for the sequels of Monteggia\u27s lesions. In our opinion, the main reason for this was inappropriate choice of operative treatment. Reporting on this very high rate of complications may hopefully draw attention to the fact that reconstructive procedures to correct the sequels of Monteggia\u27s lesions should not be attempted before learning the basic principles that need to be addressed. These are reconstructive procedures that should only be performed after a thorough study of the possible complications. Based upon this survey of our experience, we conclude that in addition to ulnar deformity correction, open reduction and stabilization of radial head are mandatory to achieve a satisfactory result.Provedena je retrospektivna analiza rezultata kirurškog liječenja zastarjelih Montegginih prijeloma u 16 djece, 6 djevojčica i 10 dječaka. Prosječena dob u vrijeme rekonstruktivne operacije bila je 7 godina i 8 mjeseci (raspon od 5 godina i 2 mjeseca do 12 godina i 10 mjeseci). Prema Badoovoj klasifikaciji bilo je 12 slučajeva tipa I, 3 tipa III i 1 tipa IV. U 11 slučajeva primijenili smo kombinaciju korektivne osteotomije ulne i krvave repozicije glavice radijusa, u 2 slučaja učinjena je samo korektivna osteotomija ulne, u 2 slučaja kombinacija korektivne osteotomije ulne i radijusa, a u jednom krvava repozicija glavice radijusa uz rekonstrukciju anularnog ligamenta. Vrijeme praćenja iznosilo je prosječno 9 godina i 6 mjeseci (raspon od 3 godine i 10 mjeseci do 17 godina). Prema Morreyevih ljestvici bilo je 9 dobrih, 4 zadovoljavajuća i 3 loša rezultata. Zabilježeno je 11 komplikacija: 2 lezije radijalnog živca, 2 pseudoartroze na mjestu osteotomije ulne, 5 reluksacija i 1 subluksacija, 1 prijelom ulne ispod mjesta ostetomije. Zbog komplikacija ponovno je operirano 7 djece, uključujući oba djeteta kod kojih je bila primijenjena kombinacija osteotomije ulne i radijusa i te oba djeteta kod kojih je bila primijenjena samo korektivna osteotomija ulne. Kirurško liječenje zastarjelih Montegginih prijeloma u našoj seriji je bilo povezano s velikim brojem komplikacija. Smatramo da je glavni uzrok tome bio neprimjeren izbor kirurškog zahvata. Uz ispravljanje deformacije ulne neophodna je i krvava repozicija i stabilizacija glavice radijusa
