Functional outcomes in pediatric patients with inveterate Monteggia fracture dislocation treated with Z osteotomy and annular ligament reconstruction with palmaris longus: a case series

Missed Monteggia fracture dislocations (MFDs) are rare injuries that are frequently associated with poor functional and cosmetic outcomes. A retrospective study was conducted on 12 patients with chronic MFDs who underwent annular ligament reconstruction using a palmaris longus autograft, combined with a novel Z-shaped ulnar osteotomy. The surgical intervention was performed, on average, 17 months after the initial trauma, with a mean follow-up period of 12 months. Following surgery, the average range of motion achieved was 128° in flexion, −1.65° in extension, and 140° in forearm pronation–supination. The overall complication rate was 16%, including ulnar nerve neuropraxia, persistent pain, and redislocation of the radiocapitellar joint. Annular ligament reconstruction using a palmaris longus autograft combined with a Z-shaped ulnar osteotomy is a reproducible and promising technique for the treatment of MFDs.