Clinical Scorecard: Comprehensive Five-in-One Surgical Technique for Managing Chronic Monteggia Fractures in Pediatric Patients

At a Glance

Key Highlights

• Five-in-one surgical approach includes Henry approach debridement, proximal ulnar osteotomy with lengthening and posterior angulation, hinged external fixator with K-wire fixation, anterior joint capsule suture repair, and plaster immobilization.
• Achieved anatomical radial head reduction in 88.2% of cases with significant improvement in elbow flexion and extension.
• No serious complications reported; redislocation rate was 11.8%; all ulnar osteotomies achieved bony union.

Guideline-Based Recommendations

Diagnosis

• Screen for radial head dislocation in children with forearm injuries, especially involving the ulna.
• Use X-ray as primary diagnostic tool; consider elbow CT and MRI for detailed assessment of dislocation and soft tissue involvement.
• Classify injury using Bado classification, with Type I being most common.

Management

• Perform open reduction of the humeroradial joint combined with proximal ulnar osteotomy for chronic cases (>4 weeks post-injury).
• Apply the five-in-one surgical protocol: Henry approach debridement, ulnar osteotomy with lengthening and angulation, hinged external fixation with K-wire stabilization, anterior capsule repair, and plaster immobilization.
• Adjust ulnar lengthening and angulation intraoperatively to ensure stable radial head reduction.

Monitoring & Follow-up

• Follow-up for at least 12 months to monitor radial head position and osteotomy healing.
• Assess elbow range of motion postoperatively, focusing on flexion and extension improvements.
• Monitor for signs of radial head redislocation and ulnar nonunion.

Risks

• Redislocation of the radial head (observed rate 11.8%).
• Potential nerve injury and heterotopic ossification in chronic cases.
• Risk of ulnar nonunion if osteotomy healing is compromised.

Patient & Prescribing Data

Children aged 4–15 years with Bado Type I chronic Monteggia fractures

Five-in-one surgical technique provides effective anatomical reduction and functional improvement with low complication rates over a mean follow-up of 15.3 months.

Clinical Best Practices

• Early diagnosis and screening of radial head dislocation in pediatric forearm injuries to prevent chronicity.
• Use the anterior Henry approach for adequate exposure and debridement of the humeroradial joint.
• Employ hinged external fixation combined with K-wire fixation to achieve and maintain stable ulnar osteotomy correction.
• Perform thorough debridement of fibrous tissue and repair of the anterior joint capsule to restore joint stability.
• Immobilize with anterior plaster slab postoperatively to support healing.

References

• Bado Classification of Monteggia Fractures
• Management of Chronic Monteggia Fractures in Children
• Henry Approach for Elbow Surgery