Five-in-one surgery: an integrated approach for chronic Monteggia fracture in children

Introduction To evaluate the clinical efficacy of the five-in-one surgical approach-comprising Henry approach debridement of the humeroradial joint, proximal ulnar osteotomy with lengthening and posterior angulation, hinged external fixator combined with ≥2 K-wire fixation of the osteotomy site, suture repair of the anterior joint capsule, and anterior plaster slab immobilization—in the treatment of chronic Monteggia fractures in children. Methods From January 2023 to January 2025, 17 children with Bado Type I chronic Monteggia fractures underwent the five-in-one surgery, with a mean follow-up of 15.3 months (range, 12–36 months). Results Anatomical reduction of the radial head was achieved and maintained in 15 patients, and all ulnar osteotomies achieved bony union. Two patients experienced redislocation of the radial head, resulting in a redislocation rate of 11.8%. Significant improvement was observed in elbow flexion (122.4 ± 12.5° vs. 126.5±6.1°, p = 0.030) and extension (−5.3 ± 7.2° vs. −2.9 ± 5.3°, p = 0.027) postoperatively, with no changes in pronation/supination. No serious complications occurred during the study. Discussion The five-in-one protocol effectively restores radiocapitellar stability and elbow function in children with Bado Type I chronic Monteggia fractures.