Combined Anterior And Posterior Approach For The Treatment Of Chronic Monteggia Fracture In Children

Objective:To explore the method and clinical efficacy of combined anterior and posterior approach for the treatment of chronic Monteggia fractures in children.Methods:22 patients were reviewed who had been treated for chronic Monteggia fracture in our department from November 2010 to January 2015. The mean age of the patients was 7.5 years, and there were 15 boys and 7 girls. The interval between the injury and surgery was from 1 to 12 months, in exception of 2 cases,3 and 5 years respectively. X-ray showed dislocation of head of radius, ulna bending towards the radial or palmar side and excessive growth of radius. There were 2 cases with the complication of radial nerve injury. The procedure consisted of open reduction and excision of fibrous scar tissure using a Henry approach in combination with ulnar osteotomy using a posterior approach.None was performed with reconstruction of the annular ligament.Results:Mean postoperative follow-up was 12.4 months (6-59 months). Surgical outcome in reference to Mackay score, excellent in 19 cases, good in 2 cases and poor in 1 case. Redislocation happened in 1 case while subdislocation in other 2 cases.At last follow-up, flexion and extension showed significant improvement (P< 0.05). Complications such as neurovascular injuries, heterotopic ossification and radioulnar synostosis were not observed.2 cases complicated with deep branch of radial nerve injury recovered within 3 monthsof surgery.Conclusion:Combined approach in the treatment of chronic Monteggia fracture in children has advantages in field exposure, intraoperative management, and postoperative complications. Anterior approach allows to directly deal with pathological intra-articular change, and to facilitate the radial nerve exploration and neurolysis. Posterior approach is convenient for ulna osteotomy.