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Treatment of late-presenting Monteggia variant with an isolated, simple flexion ulnar osteotomy

Ray, Robbie; Gaston, Mark

Journal of Pediatric Orthopaedics B: September 2014 - Volume 23 - Issue 5 - p 472–476
doi: 10.1097/BPB.0000000000000062

Radial head dislocation in children is usually associated with complete elbow dislocation or occurs as a part of a Monteggia injury. In patients without an obvious fracture of the ulna, recognizing that plastic deformation of the ulna leads to pathological bowing is a key concept in the management of this injury. Although good results have been published using osteotomy of the ulna to maintain stability after open reduction, we hypothesize that ulnar osteotomy alone may be enough to enable stable enlocation of an irreducible radial head in patients who are identified early. We present two cases of irreducible radial head dislocation, treated with ulnar osteotomy and closed radial head reduction. Both osteotomies united and both patients had an excellent functional outcome with the absence of pain or deformity and early return to function. We explain the surgical technique and compare the outcomes with alternative surgical treatments.

Department of Orthopaedics, Royal Hospital for Sick Children, Edinburgh, UK

Correspondence to Robbie Ray, MBChB, MRCS (RCPSG), Department of Orthopaedics, Royal Hospital for Sick Children, 9 Sciennes Rd, Edinburgh, Midlothian EH9 1LF, UK Tel: +44 131 536 0000; fax: +44 131 536 0853; e-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.