Treament of Neglected Monteggia Fracture Dislocation – Surgical Technique and Experience

Introduction:
Monteggia fracture-dislocation (fracture of the ulna with radiocapitellum joint dislocation) is one of the most common missed orthopedic injuries. Late treatment of neglected monteggia fracture dislocation is challenging problem. There is no consensus regarding the proper treatment method.

We described results of our surgical treatment - acute correction using open reduction of the radiocapitelar joint, excision of annular ligament without reconstruction, and ulnar osteotomy.

Methods:
During 3 years we treated 4 children 2 males and 2 females, mean age 7 years (range 6.6 – 7.7 years).

All were intaitly monteggia Bado 1 fractures. Mean time of delay between the traumas to correction was 207 days (range 44-406(. One patient was operated previously in another hospital, and was reoprated due to residual dislocation

All the patients was treated surgically using open reduction of the radiocpitellar joint, debridement of scar tissue and annular ligmanent, ulnar osteotomy, temporary fixation of the radiocpitellar joint using wire, and plate fixation of the ulna.

Results:
All patients achieved union of ulnar osteotomy after 6 weeks of immobilization. 3 patients had excellent radiocepitellar congruency and full range of motion. The patient that was reoperated have mild residual subluxation due to partial avascular necrosis of the radial head, and mild restriction of elbow extension.

Conclusion:
Based on our experience we find the described technique for the treatment of bado 1 monteggia fracture simple, safe and efficient. The previously described annular ligament reconstruction is unnecessary for this patients group, as good stability and range of motion is achieved using ulnar osteotomy fixation. We believe that acute open reduction of the radial head leads to better results comparing to gradual correction