Surgical Outcome of Neglected Monteggia Fracture-Dislocation in Pediatric Patients: A Case Series

Treatment of Monteggia fracture-dislocations can become quite complicated when the diagnosis is delayed. Objectives: We report the outcome of open reduction and ulnar osteotomy with annular ligament repair or reconstruction in pediatric patients with neglected Monteggia fracture-dislocation. Methods: In a retrospective study, pediatric patients with neglected Monteggia fracture-dislocation who underwent open reduction and ulnar osteotomy with annular ligament repair or reconstruction were included. The radiologic evaluations included the assessment of the unio‎n of the osteotomy site and elbow joint degenerative changes or peri-articular ossifications. The clinical evaluation of outcomes included the range of motion (ROM) and the Kim elbow performance score (KEPS). Results: A total number of seven patients with pediatric Monteggia fracture-dislocations and the mean age of 6.62.7 years were evaluated. The mean delayed time from injury to surgery was 53.3 31.4 days. The mean follow-up of the patients was 30.8 25.5 months. The mean flexion arc, supination, and pronation were 137.9°, 72.1°, and 65.7°, respectively. Flexion contracture was present in two cases only. The mean KEPS of the patients was 96.46.3. Accordingly, the outcome was excellent in six (85.7%) patients and good in one (14.3%). One ulnar nonunio‎n and one heterotopic ossification were recorded as post-operative complications. No case of subluxation, dislocation, or degenerative joint disease was seen in our series. Conclusions: Radial head reduction and ulnar osteotomy with annular ligament reconstruction result in acceptable radiologic and clinical outcomes in the management of neglected pediatric Monteggia fracture-dislocation.