| Summary: | 【Abstract】Objective: Although most of nerve in-juries associated with Monteggia fracture-dislocation in
children are neurapraxias and will recover spontaneously
after conservative treatment, surgical exploration of the in-volved nerve is always required in the cases with the en-trapment of posterior interosseous nerve (PIN). However,
the necessity and time frame for surgical intervention for
specific patterns of nerve dysfunction remains controversial.
The aim of the report is to observe and understand the
pathology of PIN injury associated with Monteggia frac-ture-dislocation in children, and to propose the possible
indication for the exploration of nerve.
Methods: Eight cases, six boys and two girls, with
Monteggia fracture-dislocation complicated by PIN injury,
managed operatively at the authors’ Hospital from 2007 to
2008 were retrospectively reviewed. All the patients under-went the attempted closed reduction before they received
exploration of PIN, with open reduction and internal fixation
or successful closed reduction.
Results: The PIN was found to be trapped acutely
posterior to the radiocapitellar joint in 4 out of 5 Type III
Bado’s Monteggia fractures. In the remaining cases, since
there were longer time intervals from injury to operation,
chronic compressive changes and epineural fibrosis of ra-dial nerve were visualized. After a microsurgical neurolysis
performed, the complete recovery in the nerve function was
obtained in all the cases during the follow-up.
Conclusion: The findings from this study suggest
that every case of type III Monteggia fracture-dislocation
with decreased or absent function of muscles innervated
by PIN and an irreducible radial head in children should be
viewed as an indication for immediate surgical exploration
of the involved nerve to exclude a potential PIN entrapment.
Key words: Monteggia’s fracture; Peripheral nerve
injuries; Nerve compression syndromes; Pediatrics
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