[Treatment of missed Monteggia lesion in children--case report]

A Monteggia lesion is a dislocation of the radial head associated with a fracture with the proximal third of the ulna. It is rare in children and the dislocation of the radial head is often missed at the time of injury. There are a lot of described treatment methods: open reduction of the radial head and reconstruction of the annular ligament combined with ulnar osteotomy, the same method without reconstruction of the annular ligament, gradual lengthening and angulation of the ulna by Ilizarov method without the opening of radiocapitelar joint.

A 14-year-old boy had been diagnosed with Monteggia lesion type Bado II three years before the admission to hospital. Previously nonoperatively treated, the missed radial head dislocation Bi-phase treatment had been done. Firstly, the distraction Ilizarov device was placed on the forearm, corticotomy of the ulna was done, distraction lasted fifteen days. Secondly, after achieving 1.5 cm of new bone and good level of the radial head, a reduction mechanism was incorporated into the Ilizarov device. The radiocapitelar joint was not opened, the reconstruction of the annular ligament was not done. After the radial head reduction and new bone maturation (1.5 months), the Ilizarov device was taken off.

The described method of treatment has several important advantages: radial head reduction may be done without the joint opening, the recovery is very fast and easy after that; the elbow and forearm appear cosmetically very well after the operation; the treatment process is short, the arm is in use all the time, the absence from school is not needed, the achieved result is permanent.