[Correction osteotomy of neglected "monteggia" lesion with an external fixator]

Definite reduction of the dislocated radial head to prevent further damage and loss of function in case of a neglected radial head dislocation following Monteggia lesion. Three different operation methods are demonstrated.

A correction must be striven for in any fresh injury. The indication has to be made according to the complaints in chronic dislocations. A correction is very difficult and not always successful.

In principle, none.

In principle, the surgical technique depends on the underlying disease and the kind of deformity, as well as on the instruments and implants available. There are different techniques: exclusive angulation osteotomy of the ulna (short interval after injury < 3 months), angulation osteotomy and additional lengthening of the ulna (mostly > 3 months after injury); an open procedure is seldom necessary and should be avoided.

Depending of the child's age, the technique used and the implant chosen (external fixator, plate), a cast-free treatment should be striven for (better function).

The results depend on the surgeon's experience, the accuracy of planning, and the technique chosen. An intensive postoperative physiotherapy is mandatory, frequently with initial application of CPM (continuous passive motion). Loss of correction and residual malalignments are well known and not rare. They occur mostly in instances of insufficient stability and centralization of the radial head, respectively. There are no evident numbers but this is confirmed by clinical experience.