Novel use of close-wedge osteotomy and monorail external fixator in the treatment of chronic Monteggia fracture

Abstract

Objectives: This study aims to evaluate the efficacy of closewedge osteotomy and monorail external fixator in the treatment of chronic Monteggia fracture.

Patients and methods: Between January 2014 and December 2021, data of a total of 22 patients (14 males, 8 females; mean age: 15.6±5.1 years; range, 6 to 25 years) who suffered from chronic Monteggia fractures were retrospectively reviewed. All the patients were treated for acute angulation of the ulna after osteotomy and gradual angulation for radial head reduction. Range of motion of the elbow and forearm, the angle between the longitudinal axis of proximal radius and the hypothesized Storen’s line (RSA), Visual Analog Scale (VAS), and Mayo Elbow Performance Score (MEPS), as well as Disabilities of Arm, Shoulder and Hand (DASH) score were recorded preoperatively and at the final follow-up.

Results: Objective parameters were all significantly improved in the aspects of range of motions of the elbow and forearm, and RSA (21.4±4.5° preoperatively and 2.0±1.4° at the final follow-up, t=18.20, p<0.05). The level of pain due to the chronic injury was eliminated, as the mean VAS was significantly lower at the final follow-up compared to preoperative scoring (2.8±2.0 preoperatively and 0.5±0.9 at the final follow-up, t=4.86, p<0.05). The function of the elbow and upper limb was restored, which was indicated by improved MEPS (73.2±12.5 preoperatively and 96.6±6.4 at the final follow-up, t=7.70, p<0.05) and DASH (28.3±6.0 preoperatively and 4.1±2.0 at the final follow-up, t=19.35, p<0.05). No complication was observed.

Conclusion: Close-wedge osteotomy and gradual lengthening with monorail external fixator in the treatment of chronic Monteggia fracture showed great efficacy. We also provided a specified osteotomy site aiming at PRUJ reconstruction.

Citation: Zhang R, Xue F, Liu S, Ruan H, Xu J, Kang Q. Novel use of close-wedge osteotomy and monorail external fixator in the treatment of chronic Monteggia fracture. Jt Dis Relat Surg 2022;33(2):285-293.

* Co-First Author

Shanghai Sixth People’s Hospital human research committee (Date of review 2020- 08-25, No. 2020-107). The study was conducted in accordance with the principles of the Declaration of Helsinki.

A written informed consent was obtained from each patient.
Data Sharing Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Manuscript drafting: R.Z., X.W.; Data collection: S.L.; Data analysis: H.R.; Study design: J.X., Q.K.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Received financial support from National Natural Science Foundation of China (No. 82072421) and Natural Science Foundation of Shanghai (No.20ZR1442200).