Radiocapitellar joint plasty for missed Monteggia fracture with radial head deformity in children: a Retrospective Study

Abstract

Abstract objectives The objective of our retrospective study was to review the clinical and radiological outcome of patients who were treated with radiocapitellar joint plasty. Methods This retrospective study evaluated 10 children with missed Monteggia fracture (MMF). The average time from injury to operation was 20 months. The average age of children who underwent the operation was 10.5 years old. There are 6 flat and 4 domed radial head. There are 7 type I and 3 type III according to the bado classification. All children with MMF were treated by open radial head reduction with radiocapitellar joint plasty and ulnar osteotomy with or without annular ligament (ALR). Results All patients successfully completed the operation. The average union time 4.9 ± 2.6 months. The average osteotomy angle to reduce the radial head was 15.7 ± 3.5°, and the average lengthening of the ulna was 6.1 ± 3.2 mm. At last follow-up, the average pre-operative flexion range of motion was110.5 ± 9.1° and that in the post-operative was 138.8 ± 15.1°(p < 0.05). The average pre-operative extension range of motion was10.1 ± 3.2° and that in the post-operative was 5.5 ± 3.3°(p < .05). The average pre-operative pronation range of motion was78.8 ± 8.7° and that in the post-operative was81.1 ± 5.6°(p > 0.05). The average pre-operative supination range of motion was 68.3 ± 9.7° and that in the post-operative was 80.1 ± 7.8°(p < 0.05). The pre-operative kim score was 66.5 ± 10.9 and that in the post-operative was 88.1 ± 12.6 (p < 0.05). The radial head was maintained in a completely reduced position in 9 of the10 patients and 1 subluxated. Osteoarthritic changes of the radiocapitellar joint were observed in 2 patients which is domed radial head. Conclusions Surgical approach for MMF involves radiocapitellar joint plasty is significantly effective. It has favorable functional outcomes while ensuring the maintenance of radial head reduction.