gms | German Medical Science

Objectives/Interrogation: Chronic "missed" Monteggia pathology is characterized by mild flexion deficit due to abutment of the radial head, progressive cubitus valgus with/without ular neuropathy, radiocapitellar arthrosis and pain. In a prospective patient series in 2 tertiary reference centers for this pathology in adolecents and young adults, i.e. in chronic Monteggia lesion with deformity and hypertrophy of the radial head either a radial head resection and hemi-interposition with local capsule tissue or a "functional radial head resection" after Slongo with a computerized ringfixator programmed for angular correction and concomittant lengthening of the ulnar with transfixation of radius and ulna were performed and propectively evaluated.

Methods: 20 patients (14 M, 6 F, ∅ age 16 years, range 14-25 years), all with the diagnosis of chronic Monteggia with clear deformity and arthrosis of the radial head were included in the study. After thorough clinical assessment and counselling of the Patient and the famliy one of the afore mentioned procedures (14 resection hemi- interpositions vs 6 "functional radial head resections") were performed by 2 senior upper extremity reconstructive consultant surgeons. At FU and final FU (minimum 2 years, ∅ 5 years, range 2-8 years), function, RUJ- and DUJ stability, q-DASH, PRWE, 2 quality of life scores and and cost analyis were performed.

Results and Conclusions: There were no procedure related complications in the resection hemi-interposition group i.e. no damage to the deep branch of the radial nerve nor postoperative instability. There were 2 fixator related complications, one pinsite infection resolving by antibiotics and one aseptic loosening of a radial halfpin treated by resiting of the pin, both occuring during the consolidation period. In all computerized corrections the preplanned goal was reached. 2 patients in the resection group reported mild problems at the distal radioulnar joint (moderate ulnar head abutment) and 1 patient did experience pain at the proximal end of the radius. At final FU elbow function and forearm rotation improved equally, most significant in flexion and pronation. ∅ q- Dash and PRWE improved in both groups, all patients did have better quality of life score at final FU. All patients but one (resection group) would undergo the procedure again.

Both resection interposition and computerized "functional radial head resection" can be performed to alleviate the symptoms and treat the motion deficit in patents with chronic Monteggia pathology.