Executive Editor: James Hunter

General Editor: Fergal Monsell

Authors: Andrew Howard, Peter Schmittenbecher, Theddy Slongo

Pediatric forearm shaft 22u-D/6

General considerations

Congruent and stable reduction of radiocapitellar joint dislocation requires correction of ulnar angulation and restoration of ulnar length.

If this is not achieved, the radial head can remain dislocated and if reduced can redislocate or sublux. This may lead to permanent loss of forearm function and operative treatment is recommended.

The conventional strategy to deal with a Monteggia lesion is:

  1. Stable anatomical reduction or overcorrection of the ulna
  2. Assessment of range of forearm rotation and radial head reduction and stability under image intensification
  3. If necessary, revision of ulnar fracture fixation (overcorrection/lengthening)
  4. If necessary, open reduction of the radial head

The following are options for stabilizing the ulna and achieving congruent radiocapitellar joint reduction:

  1. Closed reduction; cast fixation
  2. ESIN
  3. External fixation
  4. Plating

For stable reduction of the radial head in bowing and greenstick injuries, overcorrection with or without an ulnar osteotomy should be considered.

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v1.0 2018-11-28