The results of treatment in pediatric Monteggia equivalent lesions

Objectives: We evaluated the results of conservative and sur¬gical treatment of pediatric Monteggia equivalent lesions. Methods: The study included 13 children (3 females, 10 males; mean age 8 years; range 4 to 13 years) who under¬went treatment for Monteggia equivalent lesions. Seven pa¬tients (53.9%) had Bado type 1 and six patients (46.2%) had type 3 equivalent lesions. Two patients with type 3 equiva¬lent lesions also had a lateral humeral condyle fracture. On presentation, one patient (7.7%) had radial nerve palsy. Pri¬marily, closed reduction was attempted in all the patients ex¬cept for one patient who underwent urgent debridement and irrigation for an open fracture-dislocation. Reduction was successful in eight patients (61.5%). Upon failure of closed reduction, four patients (30.8%) underwent surgery within the first 24 hours of injury. Functional assessment was made according to the Recklingʹs criteria. The mean follow-up period was 4.1 years (range 2 to 7 years). Results: None of the patients had nonunion. Conservative treatment did not result in loss of reduction of the radius head or limitation in the range of motion of the elbow joint. Except for the patient with an open fracture-dislo¬cation leading to a poor functional result, the results were good in all the patients receiving conservative or surgical treatment. One patient (7.7%) treated conservatively devel¬oped cubitus varus (5°) and posterior angulation (20°) of the ulnar fracture line. One patient treated surgically had limitation of supination (10°) without limitation of flex¬ion or extension of the elbow joint. Accompanying radial nerve palsy in this patient disappeared in the postoperative third month. Conclusion: Closed reduction is the first choice of treat¬ment in pediatric Monteggia equivalent lesions. Surgical treatment becomes necessary if closed reduction fails.