Neglected Monteggia fracture dislocation in children: The impact of step cut osteotomy on ulna consolidation and radial head reduction. A case report

Abstract

Background: Monteggia fracture is identified as ulna fracture combined with radial head dislocation. If not diagnosed at an early stage, it leads to elbow impairment including: cubitus valgus, elbow instability and deformity, decreased supination-pronation arc and late neuropathy resulting in significant restriction of daily activities. Case report: A 10-year-old boy with a two months old Monteggia fracture dislocation labelled Bado Type 1 was evaluated. Open reduction of radial head, annular ligament repair and step cut osteotomy of the ulna were performed. Eight months after operation, the osteotomy site was fully and uneventfully consolidated and the radial head kept its stable reduction. The elbow has regained normal mobility. Conclusion: Neglected Monteggia fracture dislocation requires specific surgical management to avoid further complications. Step cut osteotomy in neglected Monteggia fracture has several advantages over other techniques. It allows the osteotomy site to be lengthened and angled forward while maintaining a large bone-to-bone contact surface which avoids the use of bone grafting. Maximizing the contact surface at the osteotomy leads to a good consolidation rate and also results in increased stability.

Keywords

• Missed Monteggia fracture
• Children
• Ulna osteotomy
• Open reduction