Management of chronic Monteggia lesion with severe radial head deformity using ulnar osteotomy, radial head replacement and ligament repair: A technical note.

Abstract

Chronic Monteggia lesions are difficult to treat when longstanding radial head dislocation results in severe radial head deformity. In such cases, corrective ulnar osteotomy with or without annular ligament repair may not achieve stable or congruent radiocapitellar reduction. This technical note describes a combined reconstructive technique using corrective ulnar osteotomy, radial head replacement, and annular ligament/lateral ligament complex repair. Through a Boyd approach, the deformed radial head is resected, and the proximal ulna is osteotomized and dorsally angulated to restore radiocapitellar alignment. The resected radial head may be used as an intercalary graft at the osteotomy site. After trial radial head replacement, the capitellum, radial head notch, and proximal ulna are contoured as needed to improve prosthetic congruity. The annular ligament, lateral ulnar collateral ligament remnant, and capsule are repaired with suture anchors to enhance stability. In chronic Monteggia lesions with severe radial head deformity, this combined technique may be useful when isolated ulnar osteotomy is unlikely to restore stable radio-capitellar articulation. A longer follow-up is needed to evaluate durability, functional outcomes, and complications.