Clinical outcome of acute Monteggia fractures in children after open reduction and internal fixation of ulna
Keywords:Monteggia fracture dislocation, Internal fixation, Plating, Bado classification
Background: Monteggia fracture dislocations are a rare but a complex injury. The fracture of the ulna associated with proximal radioulnar joint dissociation and radio capitellar dislocation. This injury comprises less than 1% of all pediatric forearm fractures and typically affects patients between 4 and 10 years of age. There are many options for treatment of these fractures. The present study was planned to assess the clinical outcome of patients treated with open reduction and internal fixation of ulna with plating.
Methods: The study was conducted in department of orthopedics, government medical college and hospital, Jammu from August 2018 to January 2021. 25 patients of Monteggia fractures were managed with open reduction and internal fixation of ulna with plating. Patients were evaluated at follow-up for pain, stability and disturbance of daily and sports activities. Functional outcome was assessed using elbow performance score.
Results: Mean age of study participants was 8.2 years and male children predominated our study constituting 17 patients (68%). 14 patients were Bado type 1, four patients were Bado type 2 whereas seven patients were Bado type 3. The outcome was excellent in 18 patients (72%) and no cases of failure were encountered.
Conclusions: Stable anatomical fixation by open reduction and internal fixation of ulna fractures with plating, that in turns leads to the stable reduction of radial head, in the management of acute Monteggia fracture dislocations in children has a very good outcome.
Monteggia G. Instituzioni Chirurgiche. Milan: Presso Giuseppe Maspero. 1814:1813-6.
Bado JL. The Monteggia lesion. Clin Orthop Relat Res. 1967;50:71-86.
Dormans JP, Rang M. The problem of Monteggia fracture dislocations in children. Orthop Clin North Am. 1990;21:251-6.
Fowles JV, Sliman N, Kassab MT. The Monteggia lesion in children. Fracture of the ulna and dislocation of the radial head. J Bone Joint Surg Am. 1983;65:1276-82.
Anderson LD, Sisk D, Tooms RE, Park WI 3rd. Compression plate fixation in acute diaphyseal fractures of the radius and the ulna. J Bone Joint Surg Am. 1975;57:287-7.
He JP, Hao Y, Shao JF. Comparison of treatment methods for paediatric Monteggia fracture: Met vs missed radial head dislocation. Medicine. 2019;98(2):e13942.
Stoll TM, Willis, Paterson DC. Treatment of the missed Monteggia fracture in the child. J Bone Joint Surg Br. 1992;74:436-40.
Korani RR. Monteggia fracture dislocation: A study on the functional outcome of surgical treatment in patients attending Osmania General Hospital, Hyderabad, Telangana, India. Int J Orthopa Sci. 2018;4(1):05-11.