|Beitragstitel||Excellent outomes of open reduction, ulnar osteotomy and external fixation without ligament repair for missed Monteggia lesions in children|
Missing an acute Monteggia fracture can, over time, lead to functional limitations by a decrease in elbow range of motion (ROM), valgus deformity, and onset of pain. Surgical reconstruction of missed Monteggia lesions is still debated, especially if the initial trauma was way back in time. The purpose of this study is to present our results of children with a neglected Monteggia fracture who were surgically treated by mini-open ulna osteotomy (OT), open reduction of the radial head and fixation with an external fixator without repair of the annular ligament.
Material and Methods
We retrospectively analyzed 29 paediatric patients, 17 girls and 12 boys, all of them treated at our institution in a standardized way for missed Monteggia fractures. Exclusion criteria were convex deformation of the radial head, grade III and IV cartilaginous lesions of the capitellum humeri and dislocation of the proximal radius into the ulnar compartment with rupture of the interosseous membrane.
Between 1998 and 2014 a total of 29 patients were treated for a missed Monteggia fracture at our institution. Average age at the time of surgery was 9.4 years (5 – 15) with an average delay of 25 months (3 – 111) between surgery and initial trauma. In 26 patients a stable reduction of the radiocapitellar joint could be achieved. Three patients showed a re-dislocation of the proximal radius on follow-up. Two of them were re-operated with increased flexion at the ulnar OT site to finally achieve stable reconstruction. In the other case of a non-ambulant patient with myelomeningocele without elbow pain and adequate ROM the proximal radius was left dislocated. Before operation 20/29 patients had limitation of elbow ROM > 10° compared to the unaffected side, with ROM remaining slightly limited in 10/29 after operation. Maintenance of a normal ROM, restoration of a normal ROM, or improvement of a restricted ROM was achieved in 93%.
Surgical treatment by ulna osteotomy, open proximal radius reduction and external fixator for missed Monteggia fractures shows excellent results in regard of elbow joint reconstruction and improvement of range of motion.