Treatment of missed Monteggia fractures in children with dual-socket external fixators

Abstract

Objective To discuss the treatment of missed Monteggia fractures in children with du-al-socket external fixators. Methods Seven patients, 6 boys and 1 girl, with missed Monteggia fracture were treated by dual-socket external fixators (Device of the wrist joint, s/n 37000, Orthofix Co., England). Their average age was 7.9 (3.5 to 11) years. Intervals between injury to operation averaged 11.7 (1 to 30) months. X-ray showed excessive growth of the radius and volar or even radial angulation of the ulna besides dislocation of the radial head. The radiohumeral joint was reached through Henry approach and any interposed tissues were cleaned. Then, oblique osteotomy at 30 degrees was performed in the proximal ulna. Once the Orthofix dual-socket fixator set properly, lengthening and then corrective angulating as well as real-time ad-justing of the osteotomy site of the ulna, according to the radiocapiteUar congruity at pronation, neutral posi-tion, and supination of the forearm, were managed under a fluoroscope. When concentric reduction was achieved, the radiocapitellar relation was secured by the repair of the annular ligament if its remnant could be dehrlded from the interposed scar in the radiohumeral space. A long-ann plaster splint was applied after op-eration and was maintained for 2 to 3 weeks. Removal of the fixator was clone only when the osteotomy site of the ulna had already got bony healing. Results All 7 patients were followed up between 3 to 26 months, with bony healing of the ulna, good radiocapitellar relationship and painless elbow joint. According to Morrey criteria, there were 6 good and 1 fair results. Conclusions Orthofix dual-socket fixators can effectively maintain the required location of the ulna after osteotomy and stabilize the proper correlation of the radio-humeral joint. Their advantages include easy adjustment during operation or even postoperatively, and early exercise of the elbow and forearm due to their finn fixation. Key words: Children; Fracture, missed; External fixators