Abstract:
BACKGROUND:The dislocated radial head in missed Monteggia fracture loses its concave articular surface and displays hypertrophic changes and flattened humeral capitellum configuration, thereby limiting the range of motion. We evaluated the results of open reduction in missed Monteggia fractures by various techniques. MATERIALS AND METHODS:Sixty-three missed Monteggia fractures were included in the analysis. We performed four combinations of operation: Group I: 22 patients treated with modified Hirayama ulnar osteotomy plus annular ligament reconstruction with free Palmaris longus grafting; Group II:18 patients treated with modified Hirayama ulnar osteotomy plus annular ligament reconstruction by the Bell Tawse's procedure; Group III-9: patients treated with only modified Hirayama's osteotomy; and Group IV: 14 patients treated with transverse osteotomy of ulna and annular ligament reconstruction by the Bell Tawse's procedure. During followup these cases were assessed for the following parameters: 1) range of motion and 2) mayo elbow performance index (MEPI). Results were noted on follow ups at 3, 6, 12 months and then on yearly basis. Sixty-three patients were followed up for an average duration of 5.6 years (range 3-8 years). RESULTS:The mean range of motion was increased by 45°, 30°, 45°, 20° for Group I, II, III and IV respectively. The average increase in MEPI scores was also almost on the same lines. There was one case of frank dislocation in group III and six cases of subluxation, two each in Groups II, III, and IV. For Annular ligament reconstruction, amongst two procedures, Groups II and IV (Bell Tawse group), had a significant extension lag contributing to the lower increase in the range of motion as compared to the Palmaris longus reconstruction group (group I). CONCLUSION:Hirayama's osteotomy is inherently more stable than the simple transverse osteotomy and it should be combined with annular ligament reconstruction. Palmaris longus graft for ligament reconstruction provides more stability as compare to Bell Towse's procedure.
journal_name
Indian J Orthopjournal_title
Indian journal of orthopaedicsauthors
Garg P,Baid P,Sinha S,Ranjan R,Bandyopadhyay U,Mitra Sdoi
10.4103/0019-5413.83946subject
Has Abstractpub_date
2011-09-01 00:00:00pages
404-9issue
5eissn
0019-5413issn
1998-3727pii
IJOrtho-45-404journal_volume
45pub_type
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journal_title:Indian journal of orthopaedics
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更新日期:2008-07-01 00:00:00
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更新日期:2012-03-01 00:00:00
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更新日期:2008-01-01 00:00:00
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journal_title:Indian journal of orthopaedics
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更新日期:2011-05-01 00:00:00
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更新日期:2015-07-01 00:00:00
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journal_title:Indian journal of orthopaedics
pub_type: 杂志文章
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更新日期:2014-11-01 00:00:00
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pub_type: 杂志文章
doi:10.4103/0019-5413.58609
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更新日期:2018-11-01 00:00:00
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更新日期:2009-07-01 00:00:00
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journal_title:Indian journal of orthopaedics
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journal_title:Indian journal of orthopaedics
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pub_type: 杂志文章
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更新日期:2016-09-01 00:00:00