Angulation osteotomy of ulna for management of missed monteggia fractures and risk factors associated with poor outcomes

Abstract

Objective: the purpose of this study is to examine the clinical and radiological outcomes, complications and risk factors associated with poor outcomes. Methods: We performed a retrospective chart evaluation in 12 patients (between march 2017–march 2020) who underwent angulation osteotomy of the ulna. Patients were evaluated in terms of demographic data, injury to surgery time interval, instability and radiologic classification given by Bado. The elbows were clinically evaluated using Mayo elbow performance score. Patients were evaluated for complications at last follow-up. Results: There were 12 patients (3 females and 9 males) with mean age at presentation as 8.58 ± 1.93years. According to Bado classification, 9 were type I and 2 were type III and one was type II. In 5 cases additionally radio-capitellar joint was exposed to remove any intervening soft tissue. The mean follow-up was 16.25 ± 1.71 months. At the last follow-up, the mean flexion-extension arc was 114.17° ± 14.43°, mean protonation arc was 64.58°± 9.40°, and supination arc was 69.58°±8.10°. The mean preoperative MEPI score at the last follow-up was 90.83 ± 13.79. Complications such as ulnar prominence at the site of angulation in 2 patients, hypertrophic scar in 2 patients, superficial infection at the surgical site were observed in one patient and re-dislocation in one patient. Conclusion: Ulnar osteotomy is effective procedure for the treatment of missed monteggia fracture. The radio-capitellar joint must be opened to remove any fibrous tissue which may prevent radial head dislocation. Patients age, fracture type, duration of injury and addition of radio-capitellar k-wire is not linked to poor outcomes. Level of evidence: III.

Keywords

• Monteggia fractures
• Bado classification
• Angulation osteotomy
• Ulnar osteotomy
• Mayo elbow performance score