Treatment of Acute Monteggia Fracture Dislocations in Children

We present our experience, of 45 cases of pediatric Monteggia fracture dislocations, treated according to ulna bone fracture patterns. These patterns of the Ulna fractures were described by P Waters, and allow for consistent clinical decision making.

Monteggia fracture dislocations in children differ from adults, in that the incomplete fracture of the ulna, which is unique to the immature bone, allows for maintenance of length and of stability. This allows for conservative treatment, in a subset of pediatric patients, but also directs other treatment considerations.

As treatment principles of Monteggia fracture dislocations are restoring and maintaining both ulnar length and alignment as well as restoring the radiocapitellar joint, addressing the ulna pattern of fracture, and not the descriptive Bado classification commonly used, is the key in treatment of these fractures.

By treating these fractures according to ulna pattern fracture, as described by P Waters, we show very good short and long term outcomes, and also report a rate of 0% re-do necessary, as previously published by Ramski and by Bae.