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Lateral ulnar collateral ligament disruption
10%
552/5794
Anterior band of the medial collateral disruption
1%
77/5794
Posterior band of the medial collateral ligament disruption
62/5794
Annular ligament interposition
85%
4923/5794
Anconeus muscle interposition
2%
136/5794
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In pediatric Monteggia fractures the annular ligament is commonly interposed in the radiocapitellar joint. Bado initially described and classified Monteggia fractures. The most common injury pattern is an extension type 1 with anterior radial head dislocation and apex anterior ulnar shaft fracture. The apex of the ulna fracture determines the direction of the radial head subluxation or dislocation. Adults typically require ORIF of the ulna. These fractures in children are often treated non-operatively with closed reduction if the ulna fracture is transverse and stable. Type III is the one most commonly associated with irreducibility of the radial head because of interposition of the annular ligament. The incidence of posterior interosseous nerve injury is high with this lesion. The nerve deficit usually completely resolves rapidly and spontaneously. Tan et al reviewed their treatment of 35 children with Type I and Type III Monteggia fractures. All radial heads were explored and the interposed annular ligament was stretched out of the joint space. They noted that none of the patients had any recurrent dislocation or subluxation. Ring et al in their review stress the importance of an anatomic reduction of the ulna to restore the reduction of the radial head.
4.2
(32)
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