Ulna osteotomy and joint capsule release and tight for old Monteggia's fracture in children

Abstract

To explore the experience and effect of surgical treatment in old Monteggia fracture in children. From January 2013 to December 2017, 32 cases of old Monteggia's fracture were treated including 18 males and 14 females with an average age of(5.3±1.2) years old ranging from 2 to 9 years old. No symptoms of radial nerve injury were found. The preoperative symptoms of the patients were the pain and deformity of the elbow joint, the flexion and extension and the limited forearm rotation. The X-ray showed the union of the ulna or the "arched sign", the dislocation of the radial head or the subluxation of the head. The posterior incision of the ulna ridge was performed in the operation, and the long oblique osteotomy was performed at the most obvious point of the ulna angle deformity. Then the Boyd incision was used to expose the humeral and radial joint and the upper ulnar radial joint. The scar tissue in the joint was cleaned and the radial head was repositioned. On the premise of maintaining the stability of the elbow joint, the ulna osteotomy was treated with plate and screw internal fixation. All 32 cases were followed up for 12 to 24 months with an average of 14.8 months, of which 1 case had incision infection. There were no pain symptoms of elbow and wrist in 32 patients after operation, 29 patients with elbow joint flexion and extension (130±5)°/0°, forearm pronation and supination 90°/(85±5)°; 2 patients with elbow flexion and extension(119°/8°, 121°/7°), forearm pronation and supination (90°/75°, 85°/60°); 1 patient with elbow flexion and extension 90°/10°, forearm pronation and supination 80°/60°. According to Mackay criteria, the result was excellent in 29 cases, good in 2 cases, medium in 1 case. Ulna osteotomy, elbow posterior capsular release, anterior capsule contraction is a effective method in the treatment of old Monteggia's fracture in children.