Retrograde Intramedullary Nailing for Bado Types Proximal Pediatric Ulna Fractures: Different Surgical Techniques

Author(s): Grégoire Thürig, Ines Raabe, Mauro Maniglio, Philippe Vial, Moritz Tannast, Emanuel Gautier

Introduction: Monteggia fracture is defined as a fracture of the proximal third of the ulna with associated dislocation of the radial head. According to the Bado classification, 4 types are differentiated. These fracture types are rare in both adults and children, reaching an incidence of 1.5 - 3% of all pediatric forearm fractures. Anatomic reduction and retention of ulnar fracture and radial head dislocation is the primary aim. If surgery is indicated, various methods can be used. However, it is not known whether one is superior to the other. In very proximal ulnar fracture with radial head dislocation, it is not known whether retrograde nailing provides effective retention of the fracture. Our hypothesis is that closed retrograde nailing is a safe method in the treatment of proximal Bado type I-III in children.

Materials and Methods: For this retrospective case series, all pediatric patients were included who suffered a proximal Bado fracture between November 2000 and August 2019. Demographics, injury patterns, details of surgical treatment, and radiographs were obtained from medical records.

Results: Results: Six pediatric cases (two to six years old, two girls and four boys). They all had a proximal Bado fracture. Closed reduction and retention using retrograde nailing of the ulna was performed in all cases. There were no infections, vascular or nerve injuries. There was one reoperation due to incorrect application of the technique. All patients were pain free and had the same range of motion as on the contralateral side.

Conclusion: Indirect reduction and intramedullary retrograde nailing is a minimally invasive technique that do not affect the blood supply of the bone and soft tissues. This technique allows for safe treatment of Bado type I-III fractures in children.