Abstract
Introduction
Early identification and conservative management of paediatric Monteggia fractures has been shown to correlate with good results. Nevertheless, several authors advocate more aggressive management with open reduction and internal fixation (ORIF) for unstable fractures. We herein present the experience of a tertiary paediatric hospital in the management of Monteggia fractures.
Methods
41 patients with Monteggia fractures (26 male and 15 female) were admitted and treated over a period of 20 years (1989 to 2009). The age of the patients ranged between 3 and 14 years (mean 7.5 years). Based on the Bado Classification, 29 fractures were type I, 3 were type II, 8 type III and 1 fracture was classified as type IV. Out of the 41 patients, 32 were managed with manipulation under anaesthesia (MUA) and above elbow plaster, whereas 9 underwent open reduction and internal fixation (ORIF) of the ulna.
Results
In order to assess outcomes, the Bruce, Harvey and Wilson scoring system was used. Assessment of range of movement, pain and deformity are evaluated to class an outcome as excellent, good, fair or poor. Patients were followed up for an average of 4.6 years (range 1 to 7). All the patients in the MUA group had excellent results. In the ORIF group 8 out of 9 patients had good results. The only patient with a fair outcome was presented 3 weeks post injury and was managed with osteotomy and ORIF of the ulna.
Discussion and conclusion
According to our recorded experience conservative management of Monteggia fractures, when indicated, results in excellent outcomes. In cases where emergency MUA fails to achieve or maintain reduction, the choice of ORIF has also demonstrated good results. Early diagnosis and management are of paramount importance as mismanaged cases demonstrate the less satisfactory results.
