Oblique sliding ulna osteotomy to treat paediatric neglected monteggia fracture dislocation.

Abstract

There have been osteotomy methods that corrected or overcorrected the ulna deformity as part of surgical treatment for chronic radial head dislocation. We reported surgical technique and outcome of oblique sliding ulna osteotomy that created acute lengthening, deformity correction or both to assist open reduction of radiocapitellar joint in four patients with neglected Monteggia fracture dislocation. Patients aged 3-12 years old had trauma duration of 4 weeks to 3 years. Two patients had Bado type I injury, and the other two had Bado type III. There was no acute nerve injury. During the final follow-up, all patients achieved union, with the limitation of motion range in the rotation arch being less than 20°. The radial head had no recurrent dislocation. This case series has shown sliding osteotomy safely, providing acute correction and lengthening of the ulna without requiring bone graft to facilitate stable reduction of the neglected Monteggia lesion.