Kawoosa et al. Journal of Medical Case Reports 2010, 4:344 http://www.jmedicalcasereports.com/content/4/1/344 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Stable relocation of the radial head without annular ligament reconstruction using the Ilizarov technique to treat neglected Monteggia fracture: two case reports Altaf A Kawoosa*, Shabir A Dhar, Mohammed Farooq Butt, Shareef A Wani, M R Mir, T A Dar Abstract Introduction: A Monteggia facture dislocation is not an uncommon injury, and the diagnosis can often be missed. Long-term follow-up of untreated Monteggia fracture dislocations reveals development of premature arthritis, pain, instability, and loss of pronation and supination. Methods involving annular ligament reconstruction require post- operative immobilization and use of transcapitellar pinning for maintenance of reduction, and thus a delay in rehabilitation. The literature reports satisfactory results with methods that involve ulnar osteotomy and open reduction of the radial head without annular ligament reconstruction. We used the Ilizarov method in two cases with neglected Monteggia fracture dislocations to stably reduce the radial head without open reduction and annular ligament reconstruction. Case presentation: We report two cases of neglected Monteggia fracture dislocation, in two Kashmiri boys aged four and six years. Using ulnar osteotomy with distraction osteogenesis, we were able to relocate the radial head gradually and maintain the reduction without a requirement for open reduction and annular ligament reconstruction. Conclusion: Distraction lengthening and hyperangulation in different planes by use of the Ilizarov technique effectively reduces the radial head without open reduction and annular ligament reconstruction. Introduction Giovanni Battista Monteggia first described in 1814 the fracture dislocation now named after him. It represents a link between injuries of the forearm and the elbow [1]. These injuries follow the course of forearm fractures prognostically if recognized and treated early. However these injuries are often missed at the time of initial trauma [2,3]. Long-term follow-up of untreated Monteggia fracture dislocations reveals development of premature arthritis, pain, instability, and loss of pronation and supination [4,5]. Thus, it is imperative to treat the neglected fracture as soon as it is diagnosed. Freedman et al. performed reconstructive procedures up to six years after injury [6]. * Correspondence: draltafk@yahoo.com Department of Orthopaedics, Government Medical College, Srinagar, Jammu and Kashmir, India Currently, chronic dislocations are treated by ulnar osteotomy, open reduction of the radial head and recon- struction of the annular ligament [7]. The literature reports excellent results [8,9], but with restricted move- ment [10,11] and development of complications [12] associated with methods involving open reduction of the radial head, and ulnar ostoetomy with or without annular ligament reconstruction. Hirayama et al., considering the interosseous membrane as the stabilizer of the radial head, described reduction of the radial head by hyperan- gulation and lengthening of the ulna without reconstruc- tion of the annular ligament [13]. Relocation of the radial head has been successfully achieved by using distraction lengthening and hyperangulation over a uniplanar lengthening device [14]. To create hyperanglation in two planes, we used the Ili- zarov method in two cases with neglected Monteggia frac- ture dislocations. Using ulnar osteotomy with distraction © 2010 Kawoosa et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.