Osteotomia da ulna para correção cirúrgica de fratura de Monteggia negligenciada em criança com deformidade plástica da ulna. Relato de caso / Ulna osteotomy for surgical correction of neglected Monteggia fracture in a child with ulna bowing. Case report

Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo

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Title Osteotomia da ulna para correção cirúrgica de fratura de Monteggia negligenciada em criança com deformidade plástica da ulna. Relato de caso / Ulna osteotomy for surgical correction of neglected Monteggia fracture in a child with ulna bowing. Case report
 
Creator Garotti, José Eduardo Rosseto
Carrenho , Leonardo
Santos Netto, Alfredo dos
 
Description AbstractIntroduction: Dislocation of the radial head with ulna bowing, when combined, constitutes a rare condition,and often missed diagnosed. Objective: Report a case of neglected Monteggia fracture in a child with ulna bowing,treated surgically with reduction and fixation of the radial head, without reconstruction of the annular ligament, andosteotomy of the ulna. Case Report: A 6-year-old male patient, victim of falling to the ground, was admitted tothe Emergency Department with complaints of pain in his right elbow. The patient was submitted to radiographicexams of the elbow, interpreted by the physician as normal. Two weeks later, the patient returned with pain, andradiographic exams of the forearm showed the presence of ulna bowing associated with dislocation of the radial head.As a treatment, we opted for open reduction and fixation of the radial head with metallic wires, associated with flexionosteotomy of the ulna. It evolved in the postoperative period with consolidation of the osteotomy, maintenance of thereduction of the radial head, and recovery of the total range of motion of the elbow and forearm. Conclusion: Pediatricpatients who present with pain in the elbow, due to a fall, should be thoroughly evaluated for the possibility of ulnabowing associated with dislocation of the radial head. Ulna osteotomy with fixation of the radial head, without reconstructionof the annular ligament, brought good results in the treatment of neglected Monteggia fracture in a child with ulna bowing. Keywords: Monteggia fracture, Ulna/deformities, Ulna  fractures, Osteotomy, Trauma, Child, Pediatrics
Introdução: A luxação da cabeça do rádio com deformidade plástica da ulna, quando combinadas, configuram uma condição rara, e frequentemente não diagnosticada na urgência. Objetivo: Relatar um caso de fratura de Monteggia negligenciada em criança com defomidade plástica da ulna, tratada cirurgicamente com redução e fixação da cabeça dorádio, sem reconstrução do ligamento anular, e osteotomia da ulna. Relato do Caso: Paciente de 6 anos de idade, sexo masculino, vítima de queda ao solo com a mão espalmada, deu entrada em Unidade de Pronto Atendimento com queixa de dor no cotovelo direito. Paciente foi submetido à exames de imagem radiográficos do cotovelo interpretados peloexaminador como sem alterações. Duas semanas após, o paciente retornou mantendo dor, e foram solicitados exames de radiografia do antebraço, que evidenciaram presença de deformidade plástica da ulna associada à luxação da cabeça do rádio. Como tratamento, optou-se pela redução aberta e fixação da cabeça do rádio com fios metálicos, associado aosteotomia de flexão da ulna fixada com fio de Kirschnner. Evoluiu no pós operatório com consolidação da osteotomia, manutenção da redução da cabeça do rádio, e recuperação do arco de movimento total do cotovelo e antebraço. Conclusão: Pacientes pediátricos que se apresentam com dor no cotovelo, em decorrência de queda com a mão espalmada, devem ser minuciosamente avaliados quanto à possibilidade de deformidade plástica da ulna associada à luxação da cabeça do rádio. A osteotomia na ulna com fixação da cabeça do rádio, sem reconstrução do ligamento anular, trouxe bom resultado no tratamento de fratura de Monteggia negligenciada em criança com defomidade plástica da ulna. Palavras chave: Fratura de Monteggia, Ulna/deformidades, Fraturas da ulna, Osteotomia, Trauma, Criança, Pediatria
Abstract
Introduction: Dislocation of the radial head with ulna bowing, when combined, constitutes a rare condition, and often missed diagnosed. Objective: Report a case of neglected Monteggia fracture in a child with ulna bowing, treated surgically with reduction and fixation of the radial head, without reconstruction of the annular ligament, and osteotomy of the ulna. Case Report: A 6-year-old male patient, victim of falling to the ground, was admitted to the Emergency Department with complaints of pain in his right elbow. The patient was submitted to radiographic exams of the elbow, interpreted by the physician as normal. Two weeks later, the patient returned with pain, and radiographic exams of the forearm showed the presence of ulna bowing associated with dislocation of the radial head. As a treatment, we opted for open reduction and fixation of the radial head with metallic wires, associated with flexion osteotomy of the ulna. It evolved in the postoperative period with consolidation of the osteotomy, maintenance of the reduction of the radial head, and recovery of the total range of motion of the elbow and forearm. Conclusion: Pediatric patients who present with pain in the elbow, due to a fall, should be thoroughly evaluated for the possibility of ulna bowing associated with dislocation of the radial head. Ulna osteotomy with fixation of the radial head, without reconstruction of the annular ligament, brought good results in the treatment of neglected Monteggia fracture in a child with ulna bowing.
Keywords: Monteggia fracture, Ulna/deformities, Ulna fractures, Osteotomy, Trauma, Child, Pediatrics
 
 
Publisher Faculdade de Ciências Médicas da Santa Casa de São Paulo
 
Date 2021-10-05
 
Type info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
 
Format application/pdf
application/pdf
 
Identifier http://arquivosmedicos.fcmsantacasasp.edu.br/index.php/AMSCSP/article/view/797
 
Source Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo; v. 66 (2021): Jan/Dez; 1 of 4
1809-3019
0101-6067
 
Language por
eng
 
Relation http://arquivosmedicos.fcmsantacasasp.edu.br/index.php/AMSCSP/article/view/797/1062
http://arquivosmedicos.fcmsantacasasp.edu.br/index.php/AMSCSP/article/view/797/1064
 
Rights Copyright (c) 2021 José Eduardo Rosseto Garotti, Leonardo Carrenho , Alfredo dos Santos Netto
https://creativecommons.org/licenses/by/4.0
 

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