Efficacies of annular ligament repair by biceps tendon for chronic Monteggia fracture in children

Objective To explore the efficacies of annular ligament repair by biceps tendon for chronic Monteggia fracture in children. Methods From February 2010 to January 2017, a total of 11 children with chronic Monteggia fractures were recruited. All of them underwent annular ligament repair by biceps tendon and ulnar osteotomy. There were 7 boys and 4 girls with an average age of 87 (50-147) months. The clinical types were Bado I (n=8) and Bado Ⅲ (n=3). The average follow-up time from injury to operation was 5 (2-11) months. And the average follow-up period was 7 (5-15) months .The outcomes were evaluated by the Mackay’s scoring system. Results Among them, there was no onset of redislocation or subluxation during the follow-up period. Only one patient experienced elbow pain. Elbow flexion, extension and forearm rotation were significantly improved postoperatively. The average degree of elbow flexion and extension were improved from preoperative 94.55 to postoperative 122.55 and the average degree of forearm rotation increased from preoperative 99.82 to postoperative 148.09. The clinical outcomes were excellent or good (90.9%) according to the Mackay's criteria. And the functional outcomes were excellent (n=7), good (n=3) and poor (n=1). Follow-up radiography showed that ulnar osteotomy was healed for all cases and there were no such complications as bone nonunion, heterotopic ossification, loosening plate, degeneration or malfomation. Internal fixation was removed at 6 months postoperatively. Two symptomatic cases of deep branch of radial nerve recovered. Conclusions Annular ligament repair by biceps tendon is effective for chronic Monteggia fracture in children. It offers the advantages of handling simplicity, fewer complications and faster recovery of joint function. Key words: Child; Monteggia's fracture; Biceps tendon; Ligaments