Chronic Monteggia lesions treatment with open reduction and Z-lengthening technique with annular ligament reconstruction.

BACKGROUND: The purpose of the present study is to evaluate the clinical and radiographic outcomes after open reduction and Z-lengthening technique with annular ligament reconstruction for the treatment of a chronic Monteggia fracture-dislocation.

MATERIAL AND METHOD: The authors postoperatively investigated the clinical and radiographic outcomes for ten children with a chronic Monteggia fracture. The present study group included seven boys and three girls mean age of nine years and one month at the time of open reduction. Each patient had been treated with open reduction of the radial head combined with ulna osteotomy and elongation, bending with z-plasty technique and annular ligament reconstruction. Clinical and radiographic outcomes were reviewed over a mean duration of follow-up of thirty-eight months.

RESULTS: The postoperative Mayo Elbow Performance Index (MEPI) at the time of follow-up ranged from 95 to 100 and no poor results. The radial head remained in a completely reduced position in ten patients. In three patients, osteoarthritic changes were observed at the radiohumeral joint. Radiographically, there were seven good, three fair and no poor results. A fair radiographic result was obtained in the patients who had undergone open reduction more than three years after the injury and two patients was operation at the age of eleven and thirteen years old.

CONCLUSION: Good clinical and radiographic outcomes can be expected if open reduction for the treatment of a chronic Monteggia fracture is performed when the patient is less than twelve years of age or within three years after the injury. Open reduction and Z-lengthening technique with annular ligament reconstruction for the treatment of a chronic Monteggia fracture-dislocation is safe with good clinical and radiologic outcomes without the need for bone graft. No nonunion is report in our series.