Korrektur von veralteten Monteggia-Verletzungen im Kindes- und Jugendalter

While adequately treated acute Monteggia lesions have a good prognosis, results in neglected Monteggia fractures are varied. Outcomes improved as a consequence of a better understanding of the pathology of the elbow joint. Persistent malposition of the radial head leads to maldevelopment of the radioulnar and radiohumeral joints. The following parameters have a crucial influence on prognosis of neglected Monteggia fractures: morphological changes of the elbow joint, duration of dislocation and the age of the patient. An individual treatment concept is necessary for an adequate correction of the complex malformations. Concerning the indications for corrective surgical procedures it is important to estimate whether they are advantageous. Not every dislocation of the radial head has to be treated and sometimes the spontaneous development can be functionally and symptomatically better than an unsuccessful attempt at correction. This publication presents the criteria which are necessary for a correct treatment of neglected Monteggia lesions. The key procedure of correction is osteotomy of the ulna which can range from simple angulation up to complex multidimensional corrections. The results of treatment of neglected Monteggia lesions depend strongly on the surgeon’s experience and the technique chosen.