Diagnosis and Treatment of Monteggia Fracture in Children

Song, Kwang Soon; Lee, Kyung Whan

Abstract

PURPOSE
To adequately diagnose Monteggia fracture which is frequently misdiagnosed at initial visit and to suggest appropriate treatment options according to the interval between initial trauma and final diagnosis.
MATERIALS AND METHODS
We analyzed retrospectively 17 Monteggia fractures in children, who had been treated from May 1993 to August 1998, with complete radiologic data, medical records and adequate follow-up period.
RESULTS
In 17 cases, six (35.3%) had inadequate diagnosis initially and the others (11 cases) were diagnosed adequately. Eleven cases diagnosed within 48 hours after initial injury were treated with closed reduction. Three cases diagnosed at more than 6 weeks after initial injury were treated with open reduction, ulnar osteotomy and annular ligament reconstruction. Two cases diagnosed at 3 weeks after initial injury were treated with only ulnar osteotomy followed by closed reduction of radial head. One refused treatment. All patients except one who refused treatment, had favorable clinical outcome in medium-term follow up.
CONCLUSION
Monteggia fracture must be suspected in children, if there was noted ulnar fracture or radial head dislocation alone is noted. Within 3 weeks after trauma, single corrective osteotomy with closed reduction of the radial head was considered enough for treatment. At more than 6 weeks after trauma, open reduction, ulnar osteotomy and annular ligament reconstruction were needed in our study.