Five-in-one surgery: an integrated approach for chronic Monteggia fracture in children

To evaluate the clinical efficacy of the five-in-one surgical approach-comprising Henry approach debridement of the humeroradial joint, proximal ulnar osteotomy with lengthening and posterior angulation, hinged external fixator combined with ≥2 K-wire fixation of the osteotomy site, suture repair of the anterior joint capsule, and anterior plaster slab immobilization-in the treatment of chronic Monteggia fractures in children.

From January 2023 to January 2025, 17 children with Bado Type I chronic Monteggia fractures underwent the five-in-one surgery, with a mean follow-up of 15.3 months (range, 12-36 months).

Anatomical reduction of the radial head was achieved and maintained in 15 patients, and all ulnar osteotomies achieved bony union. Two patients experienced redislocation of the radial head, resulting in a redislocation rate of 11.8%. Significant improvement was observed in elbow flexion (122.4 ± 12.5° vs. 126.5±6.1°, p = 0.030) and extension (-5.3 ± 7.2° vs. -2.9 ± 5.3°, p = 0.027) postoperatively, with no changes in pronation/supination. No serious complications occurred during the study.

The five-in-one protocol effectively restores radiocapitellar stability and elbow function in children with Bado Type I chronic Monteggia fractures.