Chronic anterior monteggia lesions in children: report of 4 cases treated with closed reduction by ulnar osteotomy and external fixation.
BACKGROUND
Chronic, subacute, and chronic Monteggia fracture dislocations of the elbow are challenging problems. The literature generally recommends complex open reconstructive procedures. We present an alternative, minimally invasive, percutaneous method with external fixation.


METHODS
This was a retrospective review of 4 cases presenting with chronic Monteggia lesions with anterior dislocation of the radial head.


RESULTS
Reduction of the radiocapitellar joint was successfully achieved in all patients after ulnar osteotomy and gradual correction using the Ilizarov external fixation. Open reduction or reconstruction of the radio-ulnar-capitellar joint and/or ligament was not undertaken. The patients were between 9 and 11 years of age at the time of injury. The time from injury to treatment was between 3 and 56 months. At follow-up of an average of 3.5 years (range, 2 to 6 y), all patients had full movement of the elbow and normal function of the forearm. Radiographically, all radial heads were well reduced and the ulnar osteotomy showed remodeling.


CONCLUSIONS
The technique is relatively simple and avoids the risks and technical challenges of open osteotomies, open reduction, and ligament reconstruction. Gradual reduction of the radial head with the aid of an external fixation is a safe and effective method of treatment for chronic Monteggia lesions.
*Pediatric Orthopaedic Unit, Department of Orthopaedic Surgery, Haemek Medical Center, Afula †Faculty of Medicine, Technion, Haifa, Israel ‡International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
Noam
N
Bor
Guy
G
Rubin
Nimrod
N
Rozen
John E
JE
Herzenberg
D002648:Child; D002908:Chronic Disease; D057186:Comparative Effectiveness Research; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018889:Ilizarov Technique; D004204:Joint Dislocations / Q000209:etiology / Q000601:surgery; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009011:Monteggia's Fracture / Q000150:complications / Q000601:surgery; D010027:Osteotomy / Q000379:methods; D011884:Radius / Q000601:surgery; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D014457:Ulna / Q000293:injuries / Q000601:surgery