Pathology of the annular ligament in paediatric Monteggia fractures

Abstract

To report our operative findings regarding the annular ligament in paediatric Monteggia fractures and to propose treatment recommendation for Monteggia fracture. A total of 35 children with type I and type III Monteggia fractures were treated operatively. The radial heads were all explored surgically in this series. The interposed ligament was stretched out of the joint space and was reduced around the radial head. In some of the patients, the joint capsule was repaired. Sixteen ulnar fractures were managed with open reduction and wire fixation, and 13 broken ulnas were fixed by plating. Six ulnar fractures were greenstick type and were treated by closed reduction and external fixation. All the patients were functionally excellent at the 6-month follow-up in terms of bone healing and the range of motion of the elbow joint. No redislocation or subluxation of the radial head was found until in the last follow-up. No heterotropic ossification was observed in any follow-up radiographs. The annular ligaments were intact in all paediatric patients with type I and type III Monteggia fractures and the ruptures were transversely on the joint capsule at the lower margin of the ligament. Most of the annular ligaments were interposed in the radiohumeral joint even though the radiographs showed reduction of the radial heads. We recommend reduction of the annular ligament in paediatric patients with Monteggia fractures.