gms | German Medical Science

German Congress of Orthopaedics and Traumatology (DKOU 2019)

22. - 25.10.2019, Berlin

Treatment of missed Monteggia fractures in children with unilateral external fixation. Report on 20 Patients. Pitfalls and complications

Meeting Abstract

  • presenting/speaker Giovanni Di Gennaro - Istituto Ortopedico Rizzoli, Bologna, Italy
  • Giovanni Gallone - Istituto Ortopedico Rizzoli, Bologna, Italy
  • Giovanni Trisolino - Istituto Ortopedico Rizzoli, Bologna, Italy
  • Stefano Stilli - Istituto Ortopedico Rizzoli, Bologna, Italy

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocIN18-508

doi: 10.3205/19dkou712, urn:nbn:de:0183-19dkou7129

Published: October 22, 2019

© 2019 Di Gennaro et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objectives: We describe our experience with ulnar osteotomy and progressive correction with unilateral external fixator in missed Monteggia (mM) fractures in children. The aim is to identify pitfalls and complications that may jeopardize the outcome.

Methods: Our study is a retrospective monocentric analysis. We evaluated 20 children undergoing ulnar osteotomy and progressive distraction angulation by unilateral external fixator to treat mM. 9 patients had closed reduction, while 11 patients had simultaneous open reduction, repair or reconstruction of the annular ligament and K-wire stabilization of the radio-capitellar joint. The Spearman's Rho correlation test was used to investigate the relationships between pre-operative and post-operative variables. The differences between groups were determined using the Fisher exact test for categorical variables and the independent sample t-tests for continuous variables with normal distribution.

Results: Patients were followed for averagely 3 (1-11) years. 3 children developed aseptic nonunion and 1 child had delayed union. A distal level of the osteotomy significantly increased the rate of nonunion or delayed union. At the final follow-up 8 children had complete reduction, of the radial head, 6 children had partial reduction while in 6 cases the radial head remained dislocated. The angulation and the level of the osteotomy significantly influenced the relocation, while the open reduction had no significant effect on the final position of the radial head. At the final follow-up, the Kim's score averaged 93.25. The flexion-extension arc significantly improved post-operatively, and it was positively correlated with the angulation.

Conclusion: This technique should be used in selected cases of severe and long-lasting mM in which the radial head dislocation is associated with an ulnar deformity. A correct level and angulation of the ulnar osteotomy is a crucial factor to achieve a complete and stable relocation of the radial head. The surgeon should be aware about that the shape of the radial head, the scar tissue, the interposed ligament, the heterotopic bone formation can prevent a complete relocation of the radial head, regardless of the technique used.