gms | German Medical Science

Problem: The Monteggia fracture is not a very rare paediatric injury. Reports in the literature concerning the functional outcome after operative and conservative treatment are different.

In this retrospective clinical study we present clinical and radiological long-term results of 63 patients after a minimal invasive technique with intramedullary treatment of Monteggia- fractures in childhood.

Methods: In the years 1996 to 2007 we treated 63 patients (from 2 to 12 years) with Monteggia fracture dislocations of the forearm, identified from the complete database of operating notes in our department. According to the classification of Bado (1967) the patients could be divided into four groups. There were operative treatments by closed or open reduction with internal fixation using an intramedullary stabilisation system. The clinical results were based on using the Morrey-Score with an examination of the motion in elbow function, forearm rotation, pain, force and unstableness. We also used the American Shoulder- and Elbow-Surgeons-Score (ASES) and the Dishabilities of the Arm, Shoulder and Hand-Score (DASH) as outcome questionnairies with a special view on pain and daily activity of the upper extremity.

Results and conclusions: 53 Patients were treated with closed reduction an intramedullary K-wire fixation. In 10 cases an open reduction was necessary. All fractures united within 6 weeks after the definitive procedure. There was a redislocation in 1 case. All patients who had early treatment in our department had good results on the Murrey-Score with full flexion and extension of the elbow and pronation and supination of the forearm, no pain and unstableness. The functional outcome using the ASES- and the DASH-Score is showing good results with nearly the maximum Score on all patients.There were no nerve injuries, refractures of the ulna or wound complications.

After intramedullary treatment of Monteggia fractures and Monteggia equivalent injuries in children good functional results were found. In all cases there is a free motion of the elbow joint and rotation of the forearm. Dislocations of the axis in long-term follow-ups are rare, as well as a reduction of the daily activity of the upper extremity. An early and save operative treatment is important for a good functional outcome. The minimal invasive intramedullary treatment is a simple and successfull method with a steep learning curve. The intramedullary treatment comes up to all demands for a minimal invasive operation- technique and is the state of the art for the treatment of Monteggia fractures in children.