• Bruno Stragier, Luc De Smet, and Ilse Degreef.
• Department of Orthopedic Surgery, University Hospitals Leuven, Pellenberg, Belgium. Electronic address: bruno.stragier@student.kuleuven.be.
• J Shoulder Elbow Surg. 2018 Nov 1; 27 (11): e337-e343.

BackgroundPediatric Monteggia fractures are relatively rare and are commonly missed. Radial head subluxation can persist with long-term consequences if these fractures are left untreated. We evaluated the long-term treatment outcomes after open reduction with ulnar osteotomy for missed Monteggia fractures during childhood.Materials And MethodsFourteen children were included. Our objective was to assess the clinical and radiographic postoperative outcomes. We evaluated satisfaction by questionnaire. Open reduction of the radial head was performed, combined with an opening-wedge ulnar osteotomy. The mean interval between trauma and surgery was 26.9 months (range, 1-145 months). The mean length of follow-up was 132 months (range, 67-206 months).ResultsOnly patients with a delay of more than 6 months complained of elbow tenderness. Clinical improvement (except for pronation) was obtained postoperatively, with significance found in the flexion-extension arc (P = .011). In addition, pronation loss (P = .044) and the flexion-extension arc (P = .041) improved significantly in patients with a surgical delay under 6 months compared with patients with a surgical delay of more than 6 months. Radiographically, there were 9 good and 5 fair results. We found a negative association between radiographic outcomes and both age at surgery and delay to surgery (P = .036 and P = .039, respectively).ConclusionsGood results can be obtained after open reduction with opening-wedge ulnar osteotomy. Lesser clinical and radiographic outcomes can be expected after a surgical delay of more than 6 months. Furthermore, the radiographic outcome seems better if the patient is younger than 6 years.Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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