MONTEGGIA FRACTURE-DISLOCATION IN CHILDREN

Abstract

Purpose: The purpose of this work was to study Monteggia fracture-dislocation in children and report results of treatment.

Material and methods: Thirty-two children were treated for Monteggia fracture-dislocation during a 12-year period from 1989 to 2001. The Bado classification was type I (n=22, 69%), type II (n=2, 7%), and type III (n=8, 24%). There were no type IV. Mean follow-up was seven years (1–12 yr). Mean age at treatment was six years (3–12 yr). There were 26 boys (81%) and 6 girls (19%). The right side was involved in 62% of patients. Orthopaedic treatment was use for 31 patients. Open surgery was performed for one child.

Results: Early complications were rupture and migration of the osteosynthesis material and transient palsy of the posterior interosseous in one patient. Late complications were malunion with 20° ulnar varus in four patients. Residual posterior tilt of the ulna (up to 10°) was observed in two children and anterior tilt in one other. Elbow function was perfect in all children. For children had minor cubital varus.

Discussion: Thirty-one children were given orthopaedic treatment with closed reduction of the ulnar fracture and radial head dislocation and immobilisation with a brachio-antebrachio-palmar brace. There were no cases of recurrent radial head dislocation, even with ulnar mal-union with 20° deviation. There were no cases of secondary displacement or recurrend dislocation despite rather unstable and oblique fractures. One patient required open reduction of the radial head followed by transcondylo-radial pinning. Closed reduction failed because of a ruptured annular ligament. In this patient, the pin was removed at three weeks because of pin fracture and migration to the wrist.

Conclusion: Early orthopaedic reduction is indicated as first-intention treatment for these fractures in children. The prognosis is excellent for patients treated early. When closed reduction is impossible or in the event of recurrent dislocation of the radial head, open surgery may be needed.