Background: Missed Monteggia fracture dislocation in children constitutes a significant disability with pain, stiffness, deformity and restriction of activities of daily living. Many treatment strategies have been described to manage missed Monteggia fracture dislocation and one of these strategies is the ulnar osteotomy with restoration of the ulnar length and correction of angulation to restore the elbow biomechanics in this difficult problem. The purpose of this study is to report our experience in treatment of such condition without annular ligament reconstruction.
Patients and methods: From October 2010 till September 2016, 15 patients with neglected radial head dislocation were treated by proximal ulnar angulation, distraction osteotomy, and indirect reduction of the dislocation by tensioning the interosseous membrane or direct open reduction without annular ligament reconstruction. The age of patients ranged from 5 to 12.2 years. Time from injury to surgery ranged from 4 months to 2 years. The functional outcome was evaluated according to Mayo Elbow performance score.
Results The mean follow up period was 21 (Range 18-26; SD 2.95) months. The ulnar osteotomy united in a mean time of 8.47 (Range 7-13; SD 1.55) weeks with normal length and slight overcorrection of angulation in all patients. Fourteen patients (93.33%) achieved good range of motion (ROM) with no evidence of residual radial head subluxation. Only one patient had slight posterior subluxation. The flexion-extension ROM increased postoperatively with a mean increase by 14° with significant improvement compared to the preoperative values (p = .006). On the other hand, there was no significant change (p = .881) in the preoperative versus the postoperative pronation-supination ROM. Based on the Mayo elbow performance score, the results were excellent in 8 patients (53.3%), good in 5 patients (33.3%), fair in one patient (6.7%), and poor in one patient (6.7%).
Conclusion: Ulnar osteotomy and restoration of the normal ulnar length and angulation with plate fixation without annular ligament reconstruction was an effective treatment option for Monteggia fracture dislocation with a low rate of complication and good functional outcome. |
