Five-in-One Surgical Technique for Pediatric Chronic Monteggia Fractures
Overview
The five-in-one surgical approach demonstrated effective anatomical reduction and functional improvement in children with Bado Type I chronic Monteggia fractures. Among 17 pediatric patients, 88.2% maintained radial head reduction with significant gains in elbow flexion and extension and no serious complications.
Background
Monteggia fractures, involving ulnar fracture with radial head dislocation, are rare in children but often missed initially, leading to chronic dislocations. Chronic Monteggia fractures, diagnosed after 4 weeks, present challenges including joint contracture and deformity, often requiring surgical intervention. The Bado Type I fracture, characterized by anterior radial head dislocation, is the most common pediatric subtype. Surgical outcomes worsen with longer dislocation duration, necessitating effective operative strategies.
Data Highlights
Parameter
Preoperative
Postoperative
p-value
Elbow Flexion (°)
122.4 ± 12.5
126.5 ± 6.1
0.030
Elbow Extension (°)
−5.3 ± 7.2
−2.9 ± 5.3
0.027
Radial Head Redislocation Rate
11.8% (2/17 patients)
Ulnar Osteotomy Union
100% (all patients)
Key Findings
The five-in-one surgical protocol includes Henry approach debridement, proximal ulnar osteotomy with lengthening and angulation, hinged external fixation, K-wire fixation, anterior capsule repair, and plaster immobilization.
Radial head anatomical reduction was achieved and maintained in 15 of 17 patients (88.2%).
All ulnar osteotomies achieved bony union without nonunion complications.
Significant postoperative improvements were observed in elbow flexion and extension angles.
Radial head redislocation occurred in 2 patients, representing an 11.8% redislocation rate.
No serious intraoperative or postoperative complications were reported during the follow-up period.
Clinical Implications
This comprehensive surgical approach effectively restores radiocapitellar stability and improves elbow function in pediatric chronic Monteggia fractures. Early surgical intervention and meticulous technique addressing joint debridement, ulnar osteotomy, and soft tissue repair are critical to optimize outcomes and minimize redislocation risk.
Conclusion
The five-in-one surgical technique offers a reliable and reproducible method for managing chronic Monteggia fractures in children, achieving high rates of anatomical reduction, functional recovery, and low complication rates.
References
Article Source 2025 -- Comprehensive Five-in-One Surgical Technique for Managing Chronic Monteggia Fractures in Pediatric Patients
David Brogan, MD, MSc, and Christopher Dy, MD, MPH, who are pioneering new approaches to treating brachial plexus injuries, including those caused by high-velocity trauma such as motor vehicle accidents.
