Abstract: Monteggia fracture dislocation in an uncommon injury in children. In the less severe injuries, with minimum angulation of the ulnar fracture, the radial head dislocation is frequently missed. The treatment of these late recognised injuries (more than one month) remains controversial, with frequent complications and high failure rates reported in literature. We have devised a new operative technique which has proved so far to be very successful and reliable. The procedure can be recommended only for children who have no major intra-articular injury, no epiphyseal damage and only mild adaptive changes of the radial head. It is also contraindicated if there is significant overgrowth of the radius as well as secondary changes in the proximal and distal radioulnar joints. The parents are warned of possible complications and residual loss of some movements. Under general anaesthesia, a curved longitudinal incision is made centred over the ulnar deformity extending proximally to the lateral epicondyle. The essence of the operation is the oblique ulnar metaphyseal osteotomy. The cut is made starting proximal medial to distal lateral. The osteotomy recreates the instability allowing open reduction of the radial head. It also allows for ulnar lengthening by the sliding of the osteotomised surfaces with graft interposition if necessary. The radial head is approached between the anconeus and wrist extensors, through the same exposure. The annular ligament is dividend and radial head reduced into its anatomical position. The ulna is securely fixed in the angulated position using a one third tubular plate. Finally, after checking the stability of the radial head in all forearm movements, the annular ligament is repaired. An above elbow cast is applied with forearm in supination and elbow in 90 degrees of flexion. The cast is worn for six weeks, with weekly check radiographs. Active use of the arms is encouraged after this with follow up at increasing intervals. The follow up of our cases has shown that the ulnar angulation completely remodels, with normal development of the radial head. A functional range of forearm rotation and full flexion/extension at the elbow are regained with time. We have not noted any residual subluxation/dislocations in our cases

This retrospective study was designed to evaluate the outcomes of re-dislocation of the radial head after corrective osteotomy for chronic dislocation. A total of 12 children with a mean age of 11 years (5 to 16), with further dislocation of the radial head after corrective osteotomy of the forearm, were followed for a mean of five years (2 to 10). Re-operations were performed for radial head re-dislocation in six children, while the other six did not undergo re-operation (‘non-re-operation group’). The active range of movement (ROM) of their elbows was evaluated before and after the first operation, and at the most recent follow-up.

In the re-operation group, there were significant decreases in extension, pronation, and supination when comparing the ROM following the corrective osteotomy and following re-operation (p < 0.05).

The children who had not undergone re-operation achieved a better ROM than those who had undergone re-operation.

There was a significant difference in mean pronation (76° vs 0°) between the non- re-operation and the re-operation group (p = 0.002), and a trend towards increases in mean flexion (133° vs 111°), extension (0° vs 23°), and supination (62° vs 29°). We did not find a clear benefit for re-operation in children with a re-dislocation following corrective osteotomy for chronic dislocation of the radial head.

Cite this article: Bone Joint J 2015;97-B:1582–7.

Aims

To investigate the risk factors for unsuccessful radial head reduction (RHR) in children with chronic Monteggia fractures (CMFs) treated surgically.

Purpose: To describe the pattern of injury, surgical technique and outcomes of Monteggia type IID fracture dislocations. Method: Design: Retrospective review of prospectively collected clinical and radiographic patient data in orthopaedic trauma database with prospectively collected outcome scores. Setting: Level 1 university based trauma center. Patients / Participants: All patients with Monteggia type IID fracture dislocations admitted from January 2000 to July 2005. Intervention: Review of patient demographics, fracture pattern, method of fixation, complications, additional surgical procedures, and clinical and radiographic outcome measures. Main Outcome Measurements: Clinical outcomes: elbow range of motion, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand), PREE (Patient Rated Elbow Evaluation), complications. Radiographic outcomes: quality of fracture reduction, healing time, degenerative change and heterotopic ossification. Results: Sixteen patients were included in the study. All fractures united. There were seven complications in 6 patients including 3 contractures with associated heterotopic ossification, 1 pronator syndrome and late radial nerve palsy, 1 radial head collapse and a DVT in the same patient and 1 with prominent hardware. Outcome scores were obtained on 11 patients at an average of 49 months (range 25 – 82 months) post-operatively. The average Quickdash score was 11 (range 0–43) and the average PREE score was 13 (range 0–34). Conclusion: Monteggia IID fracture dislocations are complex injuries with a recurring pattern. Rigid anatomic fixation, early range of motion and avoidance of complications leads to a good outcome

Aims

Delayed diagnosis is a well-known complication of a Monteggia fracture-dislocation. If left untreated, the dislocated radial head later becomes symptomatic. The purposes of this study were firstly, to evaluate the clinical and radiological results of open reduction of the radial head and secondly, to identify the factors that may affect the outcome of this procedure.

The type II Monteggia (posterior) lesion is a rare injury which is sometimes associated with ulnohumeral instability. We have reviewed 23 of 28 patients with this injury. A clinical and radiographic assessment was undertaken at follow-up. Functional outcome scores, including the Broberg and Morrey Index and the Disabilities of the Arm, Shoulder or Hand (DASH), were used. The results from the six patients with associated posterior ulnohumeral dislocation were compared with 17 without ulnohumeral injury. Those with dislocation had reduced movement of the elbow and had outcome scores indicative of greater disability compared to those without associated dislocation.