Late Missed Monteggia Lesions—Reconstruction of the Humeroradial Joint

Abstract

Objective:

Reconstruction of the humeroradial joint resulting in immediate functional stability.

Indications:

Missed traumatic dislocation of the radial head. Congenital dislocation of the radial head.

Contraindications:

Secondary dislocation of the radial head in instances of dysplasia or aplasia of the capitellum. Relative: deformation of the radial head in adults.

Surgical Technique:

Open reduction of the radial head without reconstruction of the annular ligament. Osteotomy of the shaft of the proximal ulna and installation of an external fixator with open clamps. Three-dimensional correction of the ulna under visual control of the humeroradial joint until the radial head is relocated in its anatomic position.

Results:

Between 01/1998 and 05/2001, we performed an osteotomy of the proximal ulna, external fixation, and open reduction of the radial head in 14 patients presenting with a late missed Monteggia lesion (Bado type I). The average age of the seven girls and seven boys at the time of reconstruction was 9 (5–15) years, the mean interval between index trauma and reconstruction amounted to 21 months (2 weeks to 7 years). Removal of the external fixator after an average of 12 (7–16) weeks. In twelve patients the reduction was maintained, and in two patients the radial head redislocated postoperatively. In one of these patients a closed reduction was successful, whereas in the other patient an open reduction was done and the external fixation modified. In both patients the joint position was maintained. Preoperatively seven out of 14 patients showed a decreased range of motion; it improved postoperatively in most. A clinical and radiologic follow-up averaging 14 (3–44) months was possible in 13 patients. No complications were recorded.