Missed Monteggia fracture dislocation in children.

Open reduction of the radial head and reconstruction of the annular ligament has been advocated for the Monteggia fracture dislocation in children who present more than a month after injury. Three patients with an anterior Monteggia lesion were treated by open reduction of the radial head which was held in place by a Kirschner wire passed from the humerus to the radius. No attempt was made either to repair or reconstruct the annular ligament. The patients were aged between 2 and 6 years, the delay between injury and reduction was between 6 and 8 weeks, and the length of follow up was 5 years for two patients and 1 year for the third. All three patients were free of pain, had no deformity and the radial head had not subluxated. All had nearly full flexion at the elbow. The forearm had full supination but restricted pronation.