Der Unfallchirurg
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Concomittant lesions of neural structures represent a rare type of complications in Monteggia's fractures. In acute fractures spontaneous neurological remission usually occurs after reduction of the dislocated radial head. In the presented case a 33-year old man experienced a trady palsy of the posterior interosseus nerve 27 years after a Monteggia's fracture with the radial head left dislocated. ⋯ Consecutively the radial nerve was surgically exposed and released from an entrapping and thickened arcade of Frohse. The radial head was left dislocated. Full neurological recovery was obtained 9 months after surgery.
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The occurrence of heterotopic ossification (HO) is a well-recognized problem after total hip replacement. In a retrospective study, we investigated 32 patients who had undergone surgical excision of symptomatic HO followed by radiation with 7 Gy and nonsteroidal anti-inflammatory drug therapy between 1994 and 1999. The mean follow-up was 20 months (range: 12-60). ⋯ At the time of follow-up examination, 18 patients (56%) assessed their pain symptoms as low but 6 patients (19%) reported strong pain symptoms. Nevertheless, the score at the time of examination (35 +/- 10) was statistically improved (p < 0.02) when compared to the preoperative score (30 +/- 8). Surgical excision of Brooker class III or IV heterotopic ossification with limited ROM followed by irradiation and anti-inflammatory prophylaxis results in significant improvement in flexion, abduction, and rotation arc and significant reduction of HO in radiographic examination at follow-up, but pain relief was only satisfactory.