Corrective Ulnar Osteotomy and Annular ligament reconstruction by fascia lata in Neglected Monteggia Fracture Dislocation in Children

Abstract

Background: Neglected Monteggia fracture dislocation in children constitutes significant disability in respect to pain, stiffness, deformity, neurological compromise and restriction of activities of daily living. Many surgical technique have been described to manage neglected Monteggia fracture dislocation and common technique is the ulnar osteotomy for restoration of the ulnar length and reduction of the radial head with annular ligament reconstruction for restoration of the elbow biomechanics for this difficult problem.

Materials and methods: In a prospective study 13 patients with mean age of 7 years and 7 months, who presented with neglected Monteggia fracture dislocation, were studied. The time interval between injury and presentation mean 7.2 months and ranged from 2 months to 25 months. Nine patients were classified as Bado type I, three as BadotypeII and one as Bado type III. All children underwent open reduction of the radiocapitellar joint, Ulnar osteotomy with angulation distraction and annular ligament reconstruction by fascia lata. We used Kim’s scorethe for evaluation of our results.

Results: The mean follow-up period was 40.8 months. One of them without ulnar osteotomies healed uneventfully. The mean of pronation was 75°, supination was 88.9°. Elbow flexion-extension range improved postoperative 13.4%. There were two patients with cubitus valgus The elbow score was excellent in ten cases, good in two cases, and fair in one cases.

Conclusion: Late open reduction for chronically dislocated radial heads in children produces good to excellent results. Surgery for reduction should be attempted unless dysmorphism of the radial head restricts it. Open reduction with ulnar osteotomy with annular ligament reduction is the most commonly performed procedure and is expected to result in reduced pain and elbow deformity.Statistically