Outcome of Missed Monteggia Fracture Dislocation by Corrective Ulnar Surgery with Plate and Screw and Radiocapitellar Stabilization in Children

Abstract

Monteggia fracture is a rare injury in children that combines a proximal ulnar fracture with radial head dislocation. Missed cases can result in chronic deformity, restricted motion, valgus instability, and long-term functional disability. Surgical management remains debatable, although corrective ulnar osteotomy with plate fixation and radiocapitellar stabilization has emerged as a reliable option. Objective: To evaluate the functional and radiological outcomes of corrective ulnar osteotomy with plate and screw fixation plus radiocapitellar stabilization in children with missed Monteggia fracture dislocations. Methodology: This quasi-experimental study was conducted at NITOR and Health & Hope Hospital, Dhaka, from January 2022 to December 2023. A total of 22 children (aged 3–18 years) with missed Monteggia fracture dislocations (>4 weeks post-injury) were enrolled. All underwent corrective ulnar osteotomy with plate and screw fixation along with radiocapitellar stabilization. Patients were followed for 24 weeks. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS), radiological outcomes by union and alignment, and complications were recorded. Statistical analysis was performed using SPSS v26; p <0.05 was considered statistically significant. Results: The mean age was 9.6 ± 2.6 years, with male predominance (72.7%). The mean injury-to-surgery interval was 9.2 ± 5.1 months. Pain improved significantly, with 31.8% of patients being pain-free post-operatively compared to none pre-operatively. MEPS scores improved from a mean of 62.0 ± 7.5 to 81.4 ± 6.9 (p <0.001). Final outcomes were rated excellent in 22.7%, good in 72.7%, and fair in 4.5% of cases. Complications occurred in 40.9%, most commonly cubitus valgus deformity (27.3%) and stiffness (13.6%). Conclusion: Corrective ulnar osteotomy with plate and screw fixation and radiocapitellar stabilization is an effective procedure for missed Monteggia fracture dislocations in children. It ensures reliable union, restores stability, and significantly improves function. Early surgical intervention within six months of injury provides the best outcomes.