Pediatric Monteggia fractures: a single-center study of the management of 40 patients.

INTRODUCTION: Early identification and conservative management of pediatric Monteggia fractures has been shown to correlate with good results. Nevertheless, several authors advocate more aggressive management with open reduction and internal fixation (ORIF) for unstable fractures. We herein present the experience of a tertiary pediatric hospital in the management of Monteggia fractures.

METHODS: Forty patients with Monteggia fractures (26 male and 14 female) were admitted and treated over a period of 20 years (1989 to 2009). The age of the patients ranged between 3 and 14 years (mean 7.5 y). On the basis of the Bado classification, 28 fractures were type I, 3 were type II, 8 type III, and 1 fracture was classified as type IV. Out of the 40 patients, 32 were managed with manipulation under anesthesia (MUA) and above-elbow plaster, whereas 8 underwent ORIF of the ulna.

RESULTS: To assess outcomes, the Bruce, Harvey, and Wilson scoring system was used. Range of movement, pain, and deformity were evaluated to class an outcome as excellent, good, fair, or poor. Patients were followed up for an average of 4.6 years (range, 1 to 7 y). All patients in the MUA group had excellent results. In the ORIF group, 8 out of 9 patients had good results.

DISCUSSION AND CONCLUSIONS: According to our recorded experience, conservative management of Monteggia fractures, when indicated, results in excellent outcomes. In cases where emergency MUA fails to achieve or maintain reduction, the choice of ORIF has also demonstrated good results. Early diagnosis and management are of paramount importance as mismanaged cases demonstrate less satisfactory results.

LEVEL OF EVIDENCE: Level IV. Case series.