Elbow reconstruction in pediatric missed monteggia lesions: revisited

Monteggia fractures are unusual injuries in children and adolescents age group wherein the radial head gets dislocated in combination with proximal ulna fractures. Various surgical treatment options are described in the literature to reconstruct these lesions for improvising the limb function. A retrospective study on thirteen patients with missed Monteggia fractures who underwent surgical intervention between 2021 to 2023 at our hospital was done. Patients underwent ulnar distraction angulation osteotomy with or without open reduction of the radial head. Patients were analysed on the visual analogue scale (VAS) for pain; mean VAS 1.9 (range 0 to 5) and functional assessment. There was a significant improvement in rotational movements of the hand after surgery. However, restriction of supination and pronation was observed in 3 patients at the last follow-up. Two patients reported radial head subluxation in last follow-up x-ray out of which one patient has associated elbow stiffness along with the re-dislocation of radial head. Missed Monteggia lesions if identified early can be treated successfully by ulnar angulation osteotomy and reduction of radio-capitellar joint. Good to excellent clinical and radiological outcomes can be expected in those with lesser age and lesser the interval between duration and surgery.