Annular ligament reconstruction in chronic Monteggia fracture-dislocations in the adult population: indications and surgical technique

Introduction: Neglected Monteggia fracture dislocation in children leads to significant restriction of daily activities by causing decreased range of motion at elbow, stiffness, deformity, and neurological compromise. Various treatment strategies have been described in the literature and one of them is ulnar osteotomy combined with reduction of radial head and annular ligament reconstruction. Aim: The aim of this study was to evaluate the results of step-cut osteotomy without the use of bone grafting with reconstruction of annular ligament in the management of neglected Monteggia fracture dislocation in children. Materials and Methods: A retrospective study was conducted in six patients with neglected Monteggia fracture dislocation with a mean age of 8.83 years. The median interval between the original injury and the corrective surgery for 6 patients was 4.4 months (range 1–12 months). All children underwent step-cut osteotomy of ulna, open reduction of radial head, and annular ligament reconstruction. Mayo Elbow Performance Index (MEPI) score was used for evaluation. Results: The ulnar osteotomies healed uneventfully without the need for a bone graft. Elbow range of motion improved post-op along with improved elbow functioning as indicated by raised MEPI score. The MEPI score was excellent in 5 cases and fair in 1 case. Conclusion: Step-cut osteotomy alone without the use of bone grafting and reinforcement with annular ligament repair is a simple yet effective technique for treating neglected Monteggia fracture dislocation.

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Stable relocation of the radial head without annular ligament reconstruction using the Ilizarov technique to treat neglected Monteggia fracture: two case reports

Journal of Medical Case Reports ◽

10.1186/1752-1947-4-344 ◽

2010 ◽

Vol 4 (1) ◽

Cited By ~ 3

Author(s):

Altaf A Kawoosa ◽

Shabir A Dhar ◽

Mohammed Farooq Butt ◽

Shareef A Wani ◽

M R Mir ◽

...

Keyword(s):

Radial Head ◽

Ligament Reconstruction ◽

Case Reports ◽

Annular Ligament ◽

Monteggia Fracture ◽

Ilizarov Technique ◽

Annular Ligament Reconstruction

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Corrective Ulnar Osteotomy and Annular Ligament Reconstruction by Fascia Lata in Neglected Monteggia Fracture Dislocation in Children.

International Journal of Orthopaedics ◽

10.17554/j.issn.2311-5106.2017.04.232 ◽

2017 ◽

Vol 4 (4) ◽

pp. 802-810

Author(s):

Nguyen Ngoc Hung ◽

◽

Phung Cong Sang ◽

Vu Tu Nam

Keyword(s):

Ligament Reconstruction ◽

Fascia Lata ◽

Fracture Dislocation ◽

Annular Ligament ◽

Monteggia Fracture ◽

Ulnar Osteotomy ◽

Annular Ligament Reconstruction ◽

Monteggia Fracture Dislocation

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Treatment of missed Monteggia fracture with intact annular ligament after an interval of 9 years: a case report and literature review

Journal of International Medical Research ◽

10.1177/0300060520949079 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094907

Author(s):

Weizheng Zhou ◽

Lianyong Li ◽

Mingzhang Mu

Keyword(s):

Functional Outcomes ◽

Open Reduction ◽

Ligament Reconstruction ◽

Annular Ligament ◽

Monteggia Fracture ◽

Mature Individual ◽

Initial Injury ◽

Annular Ligament Reconstruction ◽

Missed Monteggia

Objective Missed Monteggia fractures are commonly observed among children. Both the interval from the injury to surgery and the patient’s age at operation are thought to be correlated directly with the success of the surgery and prognosis. The aim of the present work was to report one interesting adult case of a missed Monteggia fracture with an intact annular ligament 9 years after injury and the outcomes at a 7-year follow-up. Case description One missed lesion with a 9-year delay for surgery occurred in a skeletally mature individual, and it was treated by open reduction and ulnar angulation and elongation osteotomy. The annular ligament was interpositioned intact in the radiocapitellar joint, and therefore, instead of the annular ligament reconstruction (ALR), relocation was performed. Results After one revision surgery for the complication of nonunion, good radiographic and functional outcomes were eventually sustained at the 7-year follow up. Conclusion Good radiographic and functional outcomes can be expected in adult patients in whom the annular ligament is intact and interpositioned, and this was treated by open reduction and ulnar osteotomy 9 years after the initial injury in our patient.

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