Detaillierte Beitrags-Information
| Beitragstitel | Use of retrograde intramedullary nailing technique in the reduction and fixation of pediatric Monteggia fractures type III - a report of 5 cases |
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| Beitragscode | P082 |
| Autoren | |
| Präsentationsform | Poster |
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| Abstract |
Abstract Introduction: Monteggia fractures are defined as fractures of the proximal third of the ulna with associated dislocation of the radial head. They are very rare in adults and even rare in children reaching an incidence of 0.4% - 2% of all pediatric forearm fractures. The primary goal of the treatment is the anatomical reduction of the ulnar fracture and with that the indirect anatomic reduction of the radial head. Different modalities for the treatment of Monteggia fractures in children are reported. The most frequent one is non-operative and consists in a manual reduction of the ulnar deformity and immobilization of the elbow in flexion and supination in a long-arm cast. However, due to the typical plastic deformation of the proximal ulnar fracture anatomical reduction of the deformity may be difficult to achieve by closed manipulation. As a consequence of a residual ulnar deformity subluxation of the radial head can persist and later mechanical impingement with reduced pro- supination may occur. Methods: Five cases in 6 to 8 years-old children are reported. They all had a plastic deformation of the proximal ulna with dislocation or subluxation of the radial head (all type III according to the classification of Bado). Closed reduction of the ulnar deformity was achieved utilizing retrograde nailing of the ulna using a flexible intramedullary nail. Technically, the curvature of the tip of the nail has to follow the initial deformity until some anchorage in the proximal fragment is present. The reduction was then performed with a 180° turn of the nail. Once the ulna was anatomically reduced no further manipulation for reduction of the dislocated radial head was needed. The elbow was additionally immobilized in a long arm cast for four weeks. Results: At six months, radiographically all fractures were solidly united in an anatomical position and the radio-humeral joint remained anatomically reduced. Elbow mobility was pain-free and symmetric when compared with the uninjured side. Conclusion: The described nailing technique of pediatric Monteggia fractures is a minimally invasive and efficient method combining indirect reduction and stabilization of the fracture using only one simple implant. |