Acute monteggia fractures in children.

BACKGROUND

Monteggia fracture rarely occurs in children. If it occurs, type I fracture is most commonly seen. We study the functional results of nonsurgical management in acute cases.

METHODS

From July, 1988 through October, 1994, we encountered 15 cases of acute Monteggia fractures, accounting for 2.3% of forearm fractures. Twelve were males and three were females, at an average age of 7 years and 10 months. Nine fractures occurred on left non-dominant side, six occurred on right dominant side. There were eleven type I (73.3%), no type II, three type III (20%), and one type IV (6.7%) fractures. All of these patients received closed reduction with long arm casting, and the most stable position of fracture was supination of the forearm and flexion of the elbow.

RESULTS

After follow-up for an average of 45.9 months, all fractures were found to unite without residual deformity of ulna or dislocation of the radial head. The functional results were excellent. Posterior interosseous nerve palsy occurred in one patient before treatment, and recovered spontaneously.

CONCLUSIONS

Unlike adults, children with Monteggia fractures can get excellent results from closed reduction with long arm casting.