Treatment of Sequelae after Monteggia Lesions in Childhood

Abstract

PURPOSE OF THE STUDY: To review the current methods of operative management of post-traumatic chronic radial head dislocation in chronic Monteggia lesions in children. MATERIAL AND METHODS: Post-traumatic chronic dislocation of the proximal radius usually occurs following missed or ineffectively treated Monteggia fractures. The radial head is usually dislocated anteriorly. We performed open reduction of the radial head, reconstruction of the annular ligament and corrective osteotomy of the ulna in eleven patients. Three of our patients underwent ulnar lengthening via gradual distraction using an Ilizarov external fixator. This procedure was used in nine boys and five girls who were treated for complications following Monteggia lesions between 2000 and 2009. The average age at the time of surgery was 8 years and 4 months, the average injury-to-surgery interval was 19 months, and a prerequisite for surgery was a normal concave articular surface of the proximal radius. The patients were followed up for an average of 28 months and, at final follow-up, all were fully active and had no pain or instability. RESULTS: The complications included: non-union of the ulnar osteotomy site in two patients, residual radiocapitellar subluxation in two patients, and one patient had revision surgery. Nine patients showed a full range of motion, two had a loss of extension, and three had a mean loss of pronation of 20 degrees and a mean loss of supination of 20 degrees. DISCUSSION: The Monteggia lesion is a rare fracture in childhood, but its sequelae can be serious. So far a unified therapeutic approach has not been proposed. Most authors prefer reconstruction surgery. Our results are in full agreement with the published data. CONCLUSIONS: The operative treatment of consequences after Monteggia fractures in children has a relatively high rate of complications and unpredictable results. Indications for reconstruction involve a normal articular surface of the radial head and a normal alignment of the radius and ulna. Key words: Monteggia fracture, consequences, reconstruction surgery, childhood.