gms | German Medical Science

Objectives/Interrogation: Chronic Monteggia lesion in children is often treated by open reduction of the radial head and corrective osteotomy of the ulna. However, the treatment of long-standing radial head dislocation may possibly cause poor outcomes of re-dislocation, limited forearm rotation and restriction of elbow flexion. The treatment of chronic radial head dislocation remains controversial. Despite the risk of complications, surgery is recommended for active children. In these cases, we designed radial shortening along with corrective ulnar osteotomy. The purpose of this study is to assess the clinical outcomes of our procedure.

Methods: All cases were retrospectively reviewed. Six elbows in 6 patients who were diagnosed with chronic Monteggia lesion were included in this study. All the elbows showed valgus instability and anterior radial head dislocation. The mean age at the time of operation was 13 years (range 6 to 19 years). The mean period of dislocation was 7.5 years (range 4 to 13 years and 2 cases uninjured). As surgical procedure, radial shortening at the level of proximal diaphysis and anterior capsulotomy for intracapsular observation were carried out first through anterior approach to the proximal forearm. Then corrective ulnar osteotomy and posterolateral capsulotomy if necessary were conducted through posterior approach. Finally, the annular ligament and capsules were tightened and repaired.

Results and Conclusions: In all cases, dislocated radial heads were reduced and osteotomized sites were united, and there were no cases of re-dislocation of radial head during mean follow-up periods of 17 months (range 9-36 months). Compared to preoperative conditions, all the elbows obtained good stabilities and a mean of 12 degrees of elbow flexion (range -5 to 30 degrees). Mayo elbow performance score was increased from a mean of 87 (range 70 to 90) to a mean of 97 (range 80 to 100). Meanwhile, the patients lost a mean of 13 degrees of elbow extension (range 10 to 28 degrees), 12 degrees of pronation (range -20 to 20 degrees) and 8 degrees of supination of the forearm (range 0 to 20 degrees), respectively. There were no major surgical complications. In this study, we demonstrated the short-term results of corrective ulnar osteotomy with radial shortening for long-standing chronic Monteggia lesion. Radial shortening made it easy to reduce and keep radiocapitellar congruity. Although further investigation should be needed to prove long-term effectiveness, it appears to be one of the surgical options.