Functional outcome of ulnar osteotomy and annular ligament reconstruction in neglected Monteggia fractures in Childrens

Abstract

Background: Monteggia fracture dislocations are a rare but a complex injury. Monteggia fracture is a fracture of the proximal ulna associated with dislocation of the radial head. Neglected Monteggia fracture dislocation classically implies duration of more than 4 weeks. Methods: 16 patients with Neglected Monteggia fracture were included in the study from July 2021 to December 2023. The incidence of injury was of Type I in 13 (81.25%) and Type II 3 (18.75%) cases, no cases of type III and Type IV fracture dislocation. All were treated by osteotomy of ulna with open reduction and internal fixation of ulna with plating and reconstruction of annular ligament using Bell Tawse method. Patients were evaluated at follow-up for pain, stability and disturbance of daily and sports activities. Results: Mean age of the study participants was 7.46 years (range; 6-10 years). 13 patients (81.25%) presented with Bado type 1 and 3 patients (18.75%) with Bado type 2 Monteggia fracture dislocations. All 13 (81.25%) patients of Bado type I fracture and 3 (18.75%) patients of Bado type II achieved good range of motion with no evidence of residual radial head subluxation. The functional outcome as studied using scoring by Anderson et al was excellent in 11 patients (68.7%), good in 5 patients (31.2%) and no failures were encountered. Conclusion: Our Study showed good results with ulnar osteotomy with annular ligament reconstruction using Bell Tawse procedure in neglected monteggia fractures.