{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T03:01:40Z","timestamp":1782788500567,"version":"3.54.5"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,2,4]],"date-time":"2019-02-04T00:00:00Z","timestamp":1549238400000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The treatment of missed Monteggia fracture remains a challenge, despite the various surgical methods described. The purpose of this study was to explore a new surgical technique utilizing external fixator\u2010assisted ulnar osteotomy and to assess the surgical results in a case series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirteen patients with missed Monteggia fractures were treated at our institution using this new surgical technique from August 2012 to January 2016. Our series included 11 boys and 2 girls. The left elbow was involved in 6 patients and the right elbow was involved in 7 patients. According to the Bado classification, 10 fractures were classified as Bado type I with anterior radial head dislocation and 3 were classified as Bado type III with anterolateral dislocation. The average age at the time of surgery was 5\u2009years 8\u2009months (range, 2\u2009years 2\u2009months\u201310\u2009years). The mean trauma\u2010to\u2010surgery interval was 12\u2009months (range, 2\u201336\u2009months). All patients underwent ulnar osteotomy with angulation and lengthening using a temporary external fixator, plate fixation of the osteotomy, and open reduction of the radial head dislocation without annular ligament reconstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The average follow\u2010up was 27\u2009months (range, 16\u201344\u2009months). The average operation time was 175\u2009min (range, 140\u2013215\u2009min). The average length of distraction was 0.7\u2009cm (range, 0.5\u20131.2\u2009cm) and the average angulation was 28\u00b0 (range, 20\u00b0\u201330\u00b0) at the ulnar osteotomy site intraoperatively. The elbow performance score (Kim's) was excellent in 10 cases and good in 3 cases. No neurovascular complications, compartment syndrome or implant breakage occurred. No pain in the distal radioulnar joint or limited range of motion of the wrist occurred in any patient. The radial head remained reduced in all patients with no subluxation or redislocation. However, delayed ulnar union occurred in 3 cases, all of which were successfully treated with plaster cast immobilization within approximately 6\u2009months postoperatively. One patient presented with cubitus valgus postoperatively with a carrying angle of 30\u00b0, which was 10\u00b0 greater than the contralateral carrying angle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>External fixator\u2010assisted ulnar osteotomy offers substantial flexibility for achieving the optimal positioning of the transected ulna to reduce the radial head prior to the final ulnar osteotomy fixation with a plate, thereby facilitating an effective operative performance. Our procedure is a safe and effective method to treat missed pediatric Monteggia fractures.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12426","type":"journal-article","created":{"date-parts":[[2019,2,4]],"date-time":"2019-02-04T11:30:26Z","timestamp":1549279826000},"page":"102-108","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["External Fixator\u2010assisted Ulnar Osteotomy: A Novel Technique to Treat Missed Monteggia Fracture in Children"],"prefix":"10.1111","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4240-5562","authenticated-orcid":false,"given":"Qiang","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Pediatric Orthopaedics The Third Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng\u2010meng","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopaedics 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Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopaedics The Third Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin\u2010chao","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopaedics The Third Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiu\u2010hui","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopaedics The Third Hospital of Hebei Medical University  Shijiazhuang 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