Indirect reduction of the radial head in children with chronic Monteggia lesions.

OBJECTIVE

The purpose of this study was to report the long-term follow-up results of chronic Monteggia fractures treated with angulation-translation osteotomy of ulna and closed reduction of the radial head.

DESIGN

Retrospective.

SETTING

Level 1 trauma center.

PATIENTS: We retrospectively reviewed 10 missed Monteggia fractures in children. The mean age of the patients was 7.5 years (range, 6-10 years), and there were 2 girls and 8 boys. The mean duration of time between initial injury and initial presentation was 1.7 years (range, 6 weeks to 5 years).

INTERVENTION: Closed reduction with ulna osteotomy or lengthening was performed in all 10 cases. Annular ligament reconstruction (ALR) was done in 2 cases. Final follow-up ranged from 3 to 20 years (mean 10 years).

MAIN OUTCOME MEASUREMENT: We assessed preoperative and postoperative radiographs to evaluate the quality of the radial head reduction. Clinical results were assessed according to the functional elbow score devised by Kim et al.

RESULTS

Radial head reduction was achieved and maintained in 8 of 10 cases after primary or secondary surgery. The radial head was mildly subluxated in one case and dislocated in another case at final follow-up. ALR was performed in only 2 cases. Open reduction and ALR is not required in every case, and its need should depend on intraoperative stability of radial head.