surgical outcome of neglected monteggia fracture-dislocation in pediatric patients: a case series

Background: treatment of monteggia fracture-dislocations can become quite complicated when the diagnosis is delayed. objectives: we report the outcome of open reduction and ulnar osteotomy with annular ligament repair or reconstruction in pediatric patients with neglected monteggia fracture-dislocation. methods: in a retrospective study, pediatric patients with neglected monteggia fracture-dislocation who underwent open reduction and ulnar osteotomy with annular ligament repair or reconstruction were included. the radiologic evaluations included the assessment of the union of the osteotomy site and elbow joint degenerative changes or peri-articular ossifications. the clinical evaluation of outcomes included the range of motion (rom) and the kim elbow performance score (keps). results: a total number of seven patients with pediatric monteggia fracture-dislocations and the mean age of 6.6±2.7 years were evaluated. the mean delayed time from injury to surgery was 53.3 ± 31.4 days. the mean follow-up of the patients was 30.8 ± 25.5 months. the mean flexion arc, supination, and pronation were 137.9°, 72.1°, and 65.7°, respectively. flexion contracture was present in two cases only. the mean keps of the patients was 96.4±6.3. accordingly, the outcome was excellent in six (85.7%) patients and good in one (14.3%). one ulnar nonunion and one heterotopic ossification were recorded as post-operative complications. no case of subluxation, dislocation, or degenerative joint disease was seen in our series. conclusions: radial head reduction and ulnar osteotomy with annular ligament reconstruction result in acceptable radiologic and clinical outcomes in the management of neglected pediatric monteggia fracture-dislocation.