Indirect Reduction of the Radial Head in Children With Chronic Monteggia Lesions

Abstract

Objective: The purpose of this study was to report the long-term follow-up results of chronic Monteggia fractures treated with angulation–translation osteotomy of ulna and closed reduction of the radial head. Design: Retrospective. Setting: Level 1 trauma center. Patients: We retrospectively reviewed 10 missed Monteggia fractures in children. The mean age of the patients was 7.5 years (range, 6–10 years), and there were 2 girls and 8 boys. The mean duration of time between initial injury and initial presentation was 1.7 years (range, 6 weeks to 5 years). Intervention: Closed reduction with ulna osteotomy or lengthening was performed in all 10 cases. Annular ligament reconstruction (ALR) was done in 2 cases. Final follow-up ranged from 3 to 20 years (mean 10 years). Main Outcome Measurement: We assessed preoperative and postoperative radiographs to evaluate the quality of the radial head reduction. Clinical results were assessed according to the functional elbow score devised by Kim et al. Results: Radial head reduction was achieved and maintained in 8 of 10 cases after primary or secondary surgery. The radial head was mildly subluxated in one case and dislocated in another case at final follow-up. ALR was performed in only 2 cases. Open reduction and ALR is not required in every case, and its need should depend on intraoperative stability of radial head. Key Words: chronic Monteggia lesion, ulna osteotomy, closed reduction, children Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.