Repositioning of the Annular Ligament in the Management of Missed Monteggia Fracture

Background: Successful treatment of missed Monteggia fractures usually requires ulnar osteotomy and open reduction of the radial head with reconstruction of the annular ligament. We have observed cases in which the annular ligament was displaced into the joint but remained intact. Here we report our experience with repositioning of the annular ligament at the time of the open reduction rather than reconstruction in the management of missed Monteggia fractures. Methods: We retrospectively reviewed 23 patients with missed Monteggia fractures treated by repositioning of the annular. There were 16 males and 7 females with an average age of 6 years (range, 4 to 9 y). The average time from injury to definitive treatment was 7 months (range, 6 wk to 16 mo). The average follow-up was 18 months (range, 8 to 36 mo). We evaluated the patients by clinical examination, Kim score, and radiographs. Results: All patients had no pain and full elbow function at the latest follow-up. There were no significant differences between the preoperative and postoperative Kim scores. Radiographs at the latest follow-up demonstrated maintenance of radial head reduction in all cases. Conclusions: Repositioning of an intact annular ligament in cases of missed Monteggia fractures is a viable alternative to reconstruction of the ligament and provides long-term stability. Level of Evidence: Level IV—therapeutic.