The Journal of Bone and Joint Surgery (American). 2009;91:1394-1404.
doi:10.2106/JBJS.H.00644
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Long-Term Clinical and Radiographic Outcomes After Open Reduction for Missed Monteggia Fracture-Dislocations in Children

Koichi Nakamura, MD1, Kazuhiko Hirachi, MD2, Shigeharu Uchiyama, MD1, Masatoshi Takahara, MD3, Akio Minami, MD4, Toshihiko Imaeda, MD5 and Hiroyuki Kato, MD1

1 Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. E-mail address for K. Nakamura: k_nakarc5{at}yahoo.co.jp
2 Department of Orthopaedic Surgery, Sapporo General City Hospital, Kita-11 Nishi-13, Chuo-ku, Sapporo 060-8604, Japan
3 Department of Orthopaedic Surgery, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
4 Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo 060-8638, Japan
5 Department of Food and Nutritional Environment, College of Human Life and Environment, Kinjo Gakuin University, 2-1723 Omori Moriyama-ku, Nagoya 463-8521, Japan

Investigation performed at Shinshu University School of Medicine, Matsumoto, Japan

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: There have been few reports on the long-term outcomes after the operative treatment of missed Monteggia fracture-dislocations in children. The purpose of the present study was to evaluate the long-term clinical and radiographic outcomes after open reduction for the treatment of a missed Monteggia fracture-dislocation.

Methods: We postoperatively investigated the clinical and radiographic outcomes for twenty-two children with a missed Monteggia fracture. The study group included fourteen boys and eight girls who had had a mean age of ten years (range, four years to fifteen years and eleven months) at the time of open reduction. Each patient had been managed with open reduction of the radial head combined with a posterior bending elongation ulnar osteotomy and anular ligament reconstruction. Clinical and radiographic outcomes were reviewed over a mean duration of follow-up of seven years.

Results: The postoperative Mayo Elbow Performance Index at the time of follow-up ranged from 65 to 100, with nineteen excellent, two good, one fair, and no poor results. The radial head remained in a completely reduced position in seventeen patients and was subluxated in five patients at the time of the latest follow-up. In four patients, osteoarthritic changes were observed at the radiohumeral joint. Radiographically, there were fifteen good, seven fair, and no poor results. A good radiographic result was obtained in all of the patients who had undergone open reduction within three years after the injury or before the age of twelve years, whereas a fair result was obtained in seven of the remaining eight patients.

Conclusions: If open reduction for the treatment of a missed Monteggia fracture is performed when the patient is less than twelve years of age or within three years after the injury, good long-term clinical and radiographic outcomes can be expected.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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