Proximal ulnar osteotomy in the treatment of neglected childhood Monteggia lesion

Orthop Traumatol Surg Res. 2014 Nov;100(7):803-7. doi: 10.1016/j.otsr.2014.06.022. Epub 2014 Oct 7.


Introduction: The aim of our study was to analyze medium and long-term results of proximal ulnar osteotomy with and without ligament injury in neglected Monteggia injury in children.

Material and methods: This retrospective, multicenter study included 28 patients. Clinical criteria concerned the range of motion, pain and MEPI score, and radiologic criteria comprised of Storen line, head-neck ratio, radial neck angle, and signs of osteoarthritic remodeling.

Results: Twenty-eight patients were reviewed, at a mean 6 years' follow-up (range, 2-34y). Sixteen had proximal ulnar osteotomy without ligament reconstruction, and 12 had associated ligamentoplasty. Both groups showed significant clinical and radiological improvement, with no significant difference. Patients operated within less than 1 year had better clinical and radiographic results. There was no correlation between age at surgery and quality of results. The 5 patients who underwent condyloradial pinning showed early recurrence of dislocation and osteoarthritic remodeling. The three cases of Bado type-3 lesion had early recurrence of dislocation.

Discussion: Proximal ulnar osteotomy gives good long-term results in Bado type-1 lesions, regardless of age, if performed before 1 year, in the absence of osteoarthritic remodeling. Associated ligamentoplasty does not seem to be useful.

Level of evidence: IV (retrospective).

Keywords: Children; Monteggia; Radial head dislocation; Ulnar osteotomy.

MeSH terms

  • Child
  • Child Abuse*
  • Child, Preschool
  • Elbow Joint / diagnostic imaging
  • Elbow Joint / physiopathology
  • Elbow Joint / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Male
  • Monteggia's Fracture / diagnostic imaging
  • Monteggia's Fracture / surgery*
  • Osteotomy / methods*
  • Radiography
  • Range of Motion, Articular
  • Recurrence
  • Retrospective Studies
  • Time Factors
  • Ulna / diagnostic imaging
  • Ulna / injuries
  • Ulna / surgery*