Chronic Monteggia fractures in children: outcome after treatment with the Bell-Tawse procedure

Late recognition of Monteggia fracture-dislocations of the elbow continues to pose a treatment challenge. The 15 children in our series with such chronic injuries were all treated with the modified Bell-Tawse annular ligament reconstruction. At an average follow-up of 30 months, all regained flexion-extension arcs in the functional range an no nerve palsies were noted. Some loss of pronation and supination was common, but none had activity restrictions or functional deficits. Four children had recurrent, asymptomatic radial head subluxation; measuring 3-4 mm in the anterior direction. We recommend that late annular ligament reconstruction be considered for most chronic Monteggia fractures to improve long-term function and prevent the need for late excision of the painful, chronically dislocated radial head. (c) 2004 Lippincott Williams & Wilkins.