Treatment of missed Monteggia fracture with intact annular ligament after an interval of 9 years: a case report and literature review

• Published in: Journal of international medical research Vol. 48; no. 8; p. 300060520949079
• Main Authors: Zhou, Weizheng, Li, Lianyong, Mu, Mingzhang
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.08.2020; Sage Publications Ltd; SAGE Publishing
• Subjects: Case Report; Case reports; Child; Elbow Joint; Humans; Ligaments; Ligaments - diagnostic imaging; Ligaments - surgery; Monteggia's Fracture - diagnostic imaging; Monteggia's Fracture - surgery; Open Fracture Reduction; Surgery; Ulna; Missed Monteggia fracture; case report; open reduction; ulnar osteotomy; annular ligament; radial head dislocation
• ISSN: 0300-0605; 1473-2300; 1473-2300
• DOI: 10.1177/0300060520949079

Objective Missed Monteggia fractures are commonly observed among children. Both the interval from the injury to surgery and the patient’s age at operation are thought to be correlated directly with the success of the surgery and prognosis. The aim of the present work was to report one interesting adult case of a missed Monteggia fracture with an intact annular ligament 9 years after injury and the outcomes at a 7-year follow-up. Case description One missed lesion with a 9-year delay for surgery occurred in a skeletally mature individual, and it was treated by open reduction and ulnar angulation and elongation osteotomy. The annular ligament was interpositioned intact in the radiocapitellar joint, and therefore, instead of the annular ligament reconstruction (ALR), relocation was performed. Results After one revision surgery for the complication of nonunion, good radiographic and functional outcomes were eventually sustained at the 7-year follow up. Conclusion Good radiographic and functional outcomes can be expected in adult patients in whom the annular ligament is intact and interpositioned, and this was treated by open reduction and ulnar osteotomy 9 years after the initial injury in our patient.