Description
In this lecture, Chris Prior discusses the complexities and challenges of managing delayed presentations of Monteggia fractures in pediatric patients. He begins by defining delayed presentation and emphasizing the significance of timely intervention, noting that delays can increase the need for surgical interventions by 12% for each day treatment is postponed. The case study of a five-year-old child with a recognized Monteggia fracture highlights the difficulties faced; despite a closed reduction attempt and subsequent surgery, complications arose, illustrating the challenges posed by a united fracture combined with a dislocated radial head.
Prior stresses the importance of establishing a clear clinical narrative, including historical trauma details, and achieving comprehensive imaging to plan out the necessary interventions. He presents various acceptable strategies for correcting deformities, including the use of osteotomies and the careful application of fixation devices to maintain stability during healing. Moreover, he discusses the risks associated with operating on complicated cases and the necessity of collaboration and discussions in multidisciplinary teams (MDT).
Specific strategies for surgical correction are elaborated on, outlining the technical aspects involved, including potential use of locking plates and considerations for soft tissue management. Prior discusses open reductions and the implications of annular ligament reconstruction suggesting that these approaches are often controversial.
The lecture also delves into the ethical considerations faced by the medical team when contemplating surgical options and the balance of risks versus benefits in children, emphasizing patient stability and function in the long-term follow-up. In the concluding remarks, he reinforces the need for meticulous planning of bony deformity corrections, readiness to consult with specialists, and the possibility of opting for conservative management when surgical options pose significant risks.