Successful Treatment of Chronic Monteggia Fracture-dislocations in Children---A New Reference

Abstract

\n BackgroundGreat difficulty and more failures were the descriptions of a chronic Monteggia fracture-dislocation. The treatment of chronic Monteggia lesion remains controversial and challenging for surgeons. This study aims to introduce our experience of a new reference in the treatment of chronic Monteggia fracture-dislocation in children and evaluate outcomes from clinical and radiographic findings.MethodsWe retrospectively reviewed 18 children who underwent surgical treatment because of chronic Monteggia lesion. Electronic medical records of clinical data, radiographic parameters, and operative details, were reviewed for study analysis. Parameters were compared at the time of pre-operation and the last follow-up. The relationship of lengthening and angulation of ulnar was calculated.ResultsMean interval time was 11.1\u2009±\u200915.7 months and follow-up time was 34.6\u2009±\u200923.7 months in this study. A congruent radiocapitellar reduction was observed in 15 (83.3%) patients, while 2 (11.1%) patients developed subluxation, and 1 (5.6%) patient had redislocation. The mean posterior bending angle was 12.88° (range, 3 to 25°), and the mean amount of elongation of the ulnar was 8.78 mm (range, 3.6 to 17.5 mm). The lengthening was significantly proportional to the magnitude of angulation of ulnar in good outcome patients (r\u2009=\u20090.637, p\u2009=\u20090.009), and the index was larger than the failed ones. Postoperatively, the Kim scores were obviously improved, from 59.17\u2009±\u200918.17 to 90\u2009±\u20096.64.ConclusionsWe highlight the ulnar osteotomy as the essential procedure during the reconstruction surgeries. Enough elongation and balanced angulation of the osteotomy is warranted to keep satisfactory outcomes. The ulnar should be lengthened to more than normal proportional ulnar length to stable the radial head reduction. Iliac crest autograft is recommended to avoid nonunion of ulnar osteotomy after enough lengthening.Level of evidenceLevel IV; Case Series; Treatment Study