RETRACTED ARTICLE: Missed Monteggia fracture in children: is annular ligament reconstruction always required?

Abstract

Background Missed radio-capitellar joint dislocation is one of the feared complications of Monteggia fractures, especially when associated with subtle fractures of the ulna bone. Many treatment strategies have been described to manage the chronic Monteggia fracture and the need for annular ligament reconstruction is not always clear. This study is an attempt to address the issue of annular ligament reconstruction in the surgical management of missed Monteggia fracture. Materials and methods A retrospective study was performed in 12 patients who presented with missed Monteggia fracture. All children underwent open reduction of the radio-capitellar joint. Five children (Group A) were treated with ulna angulation–distraction osteotomy and annular ligament reconstruction, and six cases required only an ulna angulation–distraction osteotomy without ligament reconstruction. The duration of missed dislocation was from 3 to 18 months (mean 9 months). Ten patients were classified as Bado I, and one each as Bado II and III, respectively. Results The mean follow up period was 22 months. All ulna osteotomies healed uneventfully. The mean loss of pronation was 15° in Group A and 10° in Group B. Elbow flexion improved from the preoperative range and no child complained of pain, deformity and restriction of activity. In one case (Group A), there was 3 mm of radiographic subluxation of the radial head, but this child was clinically asymptomatic. The elbow score was excellent in ten cases and good in two cases. Conclusion Distraction–angulation osteotomy of the ulna suffices in most cases of missed Monteggia fracture and the need for annular ligament reconstruction is based on the intra-operative findings of radial head instability.