External Fixator-assisted Ulnar Osteotomy: A Novel Technique To Treat Missed Monteggia Fracture In Children

Purpose:The treatment of missed Monteggia fracture remains was a challenge,despite the various surgical methods described.The purpose of this study was to explore a new surgical technique utilizing external fixator assisted ulnar osteotomy and assess the surgical results in a case series.Methods:17 patients with missed Monteggia fracture were treated at our institution using this technique.The average age at the time of surgery was 6years(range 2 years 2 months–10 years).The mean trauma-to-surgery interval was 12 months(range 2–36 months).All patients underwent ulnar osteotomy with angulation and lengthening using a temporary external fixator,plate fixation of the osteotomy and open reduction of the radial head dislocation without annular ligament reconstruction.Results:The average follow-up was 28 months(range 16–46 months).The elbow performance score(Kim's)was excellent in 13 cases and good in three cases.We found significant differences between the preoperative and the last follow-up flexion(P<0.05).There was no significant difference in the extension activity of the elbow joint(P>0.05),and there was no significant difference in the anterior and post rotation activity of the forearm(P>0.05).The radial head remained reduced in all patients with no subluxation or redislocation at the last follow-up.However,delayed ulnar union occurred in three cases,all of which were successfully treated with plaster cast immobilization within about 6 months postoperatively.Conclusions:External fixator-assisted ulnar osteotomy offers substantial flexibility for achieving the optimal positioning of the transected ulna to reduce the radial head prior to the final ulnar osteotomy fixation with a plate,thereby facilitating a convenient and effective operative performance.We conclude that our procedure is a safe and effective method to treat missed paediatric Monteggia fracture.