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

## TL;DR

A new surgical method called 'five-in-one' was tested for treating chronic Monteggia fractures in children, showing good results in restoring joint stability and elbow function.

## Contribution

The paper introduces a novel integrated surgical protocol combining five techniques for treating chronic Monteggia fractures in children.

## Key findings

- Anatomical reduction of the radial head was achieved in 15 out of 17 patients.
- Significant improvements in elbow flexion and extension were observed post-surgery.
- The redislocation rate was 11.8%, with no serious complications reported.

## Abstract

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.

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).

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.

The five-in-one protocol effectively restores radiocapitellar stability and elbow function in children with Bado Type I chronic Monteggia fractures.