Annular Ligament Repair using Forearm Fascia in Irreducible and Chronic Monteggia Fractures in Child

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Annular Ligament Repair using Forearm Fascia in
Irreducible and Chronic Monteggia Fractures in
Children

• C.A.Robb, C.F.Bradish, X.D.Wang
• Soochow University Childrens Hospital, Suzhou,
  China
• Royal Orthopaedic Hospital Birmingham
• Case series Nineteen patients

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Introduction

• Annular ligament can be reconstructed using
• fascia, tendon, skin, nylon or silk sutures.
• The Bell Tawse procedure uses a strip of
• triceps tendon fascia.
• Forearm fascia too weak Bell Tawse 1963

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Approach

• Proximally, Gordons
• approach, between
• anconeus and ECU
• exposes the radial head
• Distally, an extension of
• Boyds approach
• exposes the ulna shaft

From Campbells Operative Orthopaedics 10th Edn
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Method

• 1) Forearm fascial strip 1.5cm x 7cm retain
  proximal attachment
• 2) Wrap fascia around the radial neck and reduce
• 3) Check forearm rotation
• 4) Any ulna deformity managed with ulna
  lengthening (0.5 cm) and plate stabilization.
• 5) Check stability using fluoroscopy.
• 6) Six weeks in a posterior long arm splint,
  90elbow flexion and full supination

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Forearm Fascial Strip
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Results

• Stability of the radial head achieved in all
  cases
• Andersons criteria used to evaluate outcome
• Excellent 10 patients
• Satisfactory 8 patients
• Unsatisfactory 1 patient
• Failure 0 patients

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Complications

• One patient developed radio-ulnar synostosis
  following recovery from compartment syndrome
• Two radio-capitellar K-wires broke while in
  plaster in the initial period of using this
  technique

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Discussion

• Poorer results were achieved with delay in
• diagnosis beyond six months
• Patients should be warned of a potential
• reduction in forearm rotation
• Reducing the radial head prevents future problems
  with growth

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Conclusion

• Avoids proximal wound extension to obtain triceps
  fascia
• Allows a tourniquet on the upper arm
• Permits simultaneous ulna correction and fixation
  
• Bell Tawse anxieties unfounded