Relocation of the radial head with minimal invasive approach using the Ilizarov technique in neglected Monteggia fracture

Abstract

Introduction: Missed or Neglected Monteggia fracture dislocation classically implies a duration of more than 4 weeks. Two factors of significant deformity and delayed presentation constitute the problem of management of old Monteggia fracture-dislocation in paediatric age group. Restoration of radiocapitellar joint and biomechanics of the elbow joint is of paramount importance for favourable long term functional outcome. Long-term follow-up of untreated Monteggia fracture dislocations reveals development of premature arthritis, pain, instability, loss of pronation and supination, valgus deformity and a prominence on the anterior aspect of the elbow. Tardy nerve palsies have been reported subsequent to long-standing unrecognized Monteggia lesions. Thus, it is imperative to treat the neglected fracture as soon as it is diagnosed. We used the Ilizarov method using ulnar osteotomy with distraction osteogenesis to produce controlled lengthening to restore the radiocapitellar articulation Aims and Objectives: To evaluate the outcome of relocation of the radial head with minimal invasive approach using the Ilizarov technique in neglected Monteggia fracture in respect to mean increase in Mayo Elbow Performance Index (MEPI). Conclusion: Neglected Monteggia fracture dislocation in children can produce significant orthopaedic complications with gross restriction of activities of daily living. Early diagnosis and prompt management results in favourable long term outcome. Restoration of ulnar length and reduction of the radial head with minimal invasive approach using the Ilizarov technique and transcapitellar pinning is a more biological option for the restoration of the elbow biomechanics and increase in the Mayo Elbow Performance Index.