Neglected Monteggia fracture-dislocations in children

Abstract

Aim Presently, there are few large-scale studies and no clear consensus on the type of osteotomy or ligamentoplasty to be performed in neglected Monteggia fractures-dislocations cases. The goal of this study was to report the results from neglected Monteggia fractures and dislocations.MethodsThirteen children and adolescents with neglected Monteggia fractures and dislocations were treated between 2009 and 2012. There were 11 males and two females with a mean age of 8.5 (range 2–15) years. Based on the BADO classification, 11 patients had type 1, one patient had type 3, and one patient had type 4 injuries. Time delay from symptom onset to fracture was 8.84 (3-24) months. The data were analyzed using R version 3.1.1 and multiple statistical analyses were conducted.Results A postoperative Mayo Elbow Performance Index (MEPI) at the time of follow-up was recorded. Nine patients received an excellent grade, while three had good and one had a fair result with no poor results recorded. Radiographically, there were nine good, four fair, and no poor score results. The length of hospitalization was a mean of 3 days. The mean duration of follow-up was 2.9 (range 1.5-4.5) years from the initial presentation, and only one patient developed subluxation for which no additional intervention was performed.Conclusion This case series demonstrates that early diagnosis increases
the success rate in patients younger than 10 years and less than a 1-year interval between the trauma and diagnosis. Unless it is kept for a prolonged time, a condyloradial pin can be applied in necessary cases. Level of evidence: IV

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