A prospective study on surgical management of neglected Montaggia fracture in children without annular ligament repair

Abstract

Background: Monteggia fracture presenting after 4 weeks of injury termed as neglected monteggia fracture.There are many options for management of this fracture. The present study was planned with objective to assess clinical outcome of patients who were treated with a specific technique of ulnar osteotomy without annular ligament repair. Methods: This prospective study was conducted in Department of Orthopaedics MKCG Medical College and Hospital, Berhampur from July 2015 to April 2018 where 15 patients of neglected monteggia fracture were operated with specific technique of ulnar osteotomy without annular ligament repair. Participants were followed up and at end point they were evaluated for pain, stability, and disturbance of daily and sporting activities. Function was assessed using elbow performance score. Data collected were analyzed in SPSS (version 16.0). Results: Mean age of study participants was 7.3 year and male constituted majority (60%). There were 11 children with Bado type I, 3 with type II and one with type III injury. The mean time from initial injury was 8.8 months. All had limited range of movements of forearm and elbow. All patients had regular follow up for 9 months to 24. In 53.3% flexion arc was improved. The mean flexion arc was increased by 20 degree and pronation-supination arc was reduced by 20 degree. Conclusions: The present study revealed that osteotomy in neglected monteggia fracture brings stability of elbow joint and this surgical management of neglected monteggia fracture without annular ligament reconstruction had good outcome. Annular ligament reconstruction is not always necessary.