Introduction. A Monteggia lesion is a dislocation of the radial head
associated with a fracture with the proximal third of the ulna. It is rare in
children and the dislocation of the radial head is often missed at the time
of injury. There are a lot of described treatment methods: open reduction of
the radial head and reconstruction of the annular ligament combined with
ulnar osteotomy, the same method without reconstruction of the annular
ligament, gradual lengthening and angulation of the ulna by Ilizarov method
without the opening of radiocapitelar joint. Case Outline. A 14-year-old boy
had been diagnosed with Monteggia lesion type Bado II three years before the
admission to hospital. Previously nonoperatively treated, the missed radial
head dislocation Bi-phase treatment had been done. Firstly, the distraction
Ilizarov device was placed on the forearm, corticotomy of the ulna was done,
distraction lasted fifteen days. Secondly, after achieving 1.5 cm of new bone
and good level of the radial head, a reduction mechanism was incorporated
into the Ilizarov device. The radiocapitelar joint was not opened, the
reconstruction of the annular ligament was not done. After the radial head
reduction and new bone maturation (1.5 months), the Ilizarov device was taken
off. Conclusion. The described method of treatment has several important
advantages: radial head reduction may be done without the joint opening, the
recovery is very fast and easy after that; the elbow and forearm appear
cosmetically very well after the operation; the treatment process is short,
the arm is in use all the time, the absence from school is not needed, the
achieved result is permanent.
Instability of the proximal radioulnar joint in Monteggia fractures—an experimental study