Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children.
BACKGROUND
There have been few reports on the long-term outcomes after the operative treatment of missed Monteggia fracture-dislocations in children. The purpose of the present study was to evaluate the long-term clinical and radiographic outcomes after open reduction for the treatment of a missed Monteggia fracture-dislocation.


METHODS
We postoperatively investigated the clinical and radiographic outcomes for twenty-two children with a missed Monteggia fracture. The study group included fourteen boys and eight girls who had had a mean age of ten years (range, four years to fifteen years and eleven months) at the time of open reduction. Each patient had been managed with open reduction of the radial head combined with a posterior bending elongation ulnar osteotomy and anular ligament reconstruction. Clinical and radiographic outcomes were reviewed over a mean duration of follow-up of seven years.


RESULTS
The postoperative Mayo Elbow Performance Index at the time of follow-up ranged from 65 to 100, with nineteen excellent, two good, one fair, and no poor results. The radial head remained in a completely reduced position in seventeen patients and was subluxated in five patients at the time of the latest follow-up. In four patients, osteoarthritic changes were observed at the radiohumeral joint. Radiographically, there were fifteen good, seven fair, and no poor results. A good radiographic result was obtained in all of the patients who had undergone open reduction within three years after the injury or before the age of twelve years, whereas a fair result was obtained in seven of the remaining eight patients.


CONCLUSIONS
If open reduction for the treatment of a missed Monteggia fracture is performed when the patient is less than twelve years of age or within three years after the injury, good long-term clinical and radiographic outcomes can be expected.
Nakamura
Koichi
K
Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. k_nakarc5@yahoo.co.jp
Hirachi
Kazuhiko
K
Uchiyama
Shigeharu
S
Takahara
Masatoshi
M
Minami
Akio
A
Imaeda
Toshihiko
T
Kato
Hiroyuki
H
D000293:Adolescent; D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003951:Diagnostic Errors; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D009011:Monteggia's Fracture / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014457:Ulna / Q000601:surgery; D000092464:Elbow Injuries