The treatment of chronic radial head dislocation in Monteggia fracture without annular ligament reconstruction

Introduction: The treatment of neglected radial head dislocation after missed Monteggia fracture dislocation in children is a controversial issue. The purpose of this study is to report our clinical experience in the treatment of the condition without annular ligament reconstruction. Method: This is a retrospective review of 20 patients between 2008 and 2014. Procedures included open reduction of the radial head and ulnar lengthening angulation osteotomy. In cases of unstable radial head reduction, a trans-capitellar K wire was applied. The pre- and post-operative radiographs were available for evaluation as well as the Mayo Elbow Performance Index (MEPI). Results: The average pre-operative elbow extension-flexion arc was 99.5° and pronation-supination arc was 151°. At last follow-up, the flexion of elbow had significant improvement (from 110° to 124°), while the average pronation and supination arc decreased, most in pronation (from 75° to 65°). Post-operatively, MEPI scored higher, especially in elbow pain and stability. Patients underwent surgery within one year of injury had better functional outcome than those injured over one year. The patients required trans-capitellar K wire for unstable radial head reduction and were in the older age group. At final follow-up, the reduction of radial head was maintained in all cases except two with mild subluxations of the radial head in radiographs. Two cases required radial shaft shortening to facilitate the reduction because of proximal migration of the radius. Conclusion: For neglected radial head dislocation following Monteggia fracture dislocation, we presented our surgical strategy to reduce the radial head without annual ligament reconstruction. Our patients functionally benefited from the procedure with significant improvement in elbow pain and stability, as well as improved flexion of the elbow with stable radial head reduction. Level of evidence: IV.