title: Outcomes after surgical treatment of missed Monteggia fractures in children.
abstract: BACKGROUND
  Chronic dislocation of the radial head treatment in Monteggia fracture dislocation is still controversial. We present a large series of patients treated in our Institution.
  
  
  METHODS
  The outcome of 22 children treated surgically between 1988 and 2011 for post-traumatic chronic radial head dislocation is reported. There were 12 girls and 10 boys with a mean age at surgery of 7.2 years (4.1-13.6). The mean interval between injury and treatment was 15.7 months (1-128). Nine patients underwent open reduction with removal of interposed tissue and repair (7) or Bell-Tawse reconstruction (2) of the annular ligament. Ten patients underwent osteotomy, gradual lengthening and angulation of the ulna by external fixation. Two patients underwent angular osteotomy of the proximal ulna with open wedge, open reduction in the radial head and reconstruction of the annular ligament. One patient admitted to the hospital 10 years after injury underwent radial head excision at 13.7 years of age.
  
  
  RESULTS
  After a mean follow-up of 5.5 years (1-24.3), the radial head stayed reduced in 15 patients and subluxated in 5. In one case, redislocation occurred. All patients but five were pain-free. The elbow performance score (Kim score) was excellent in 14 cases, good in four and fair in four, with a mean score of 91, corresponding to a good result. Complications included a transient posterior interosseus nerve palsy (1), and one non-union of the ulna.
  
  
  CONCLUSIONS
  Chronic Monteggia lesions must be treated. The clinical outcomes are usually better than the congruency of the radiocapitellar joint.
authors.affiliation: Pediatric Orthopaedic and Trauma Division, Istituto Ortopedico Rizzoli, Bologna, Italy. gianluigidigennaro@tin.it.
authors.forename: Giovanni L
authors.initials: GL
authors.lastname: Di Gennaro
authors.affiliation: Pediatric Orthopaedic and Trauma Division, Istituto Ortopedico Rizzoli, Bologna, Italy. martinelli@doctor.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Martinelli
authors.affiliation: Pediatric Orthopaedic and Trauma Division, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Bettuzzi
authors.affiliation: Pediatric Orthopaedic and Trauma Division, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Antonioli
authors.affiliation: Shoulder and Elbow Surgery Unit, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rotini
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009011:Monteggia's Fracture / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D016896:Treatment Outcome
keywords: Chronic radial head dislocation; External fixation; Monteggia fracture dislocation; Treatment