Sculpting Solutions: 3D-Printed Models Transform Osteotomy Planning in Monteggia Fractures

Abstract

Introduction: A neglected Monteggia fracture refers to a proximal ulna fracture accompanied by a dislocated radial head that remains untreated for a duration exceeding 4 weeks following the initial injury. We present the case of a complex neglected Monteggia fracture and its unique pre-operative approach for radial head osteotomy using 3D-printed models.

Case report: An 8-year-old girl presented with a delayed diagnosis of a Monteggia fracture, which had become increasingly complex due to late intervention and prior inadequate management. We discuss the clinical presentation, radiological features, differential diagnosis, treatment options, and long-term outcomes using a unique pre-operative approach.

Conclusion: 3D printing has been used around the world in orthopaedics for a myriad of fractures but we present the novel technique used in this case of a neglected Monteggia fracture which gave us access to tactile feedback of the radial head deformity with its relation to the ulnar and the capitellum which served as a blueprint in planning the osteotomy/reconstruction procedure thus improving our accuracy, efficiency intraoperatively and better overall patient outcome post-operatively.

Keywords: 3D; Neglected; monteggia; osteotomy; tactile.

Figure 1

(a and b) Radiograph of the left elbow taken at the time of initial injury, showing anterior dislocation of the radial head with fracture of the proximal ulna, consistent with a Bado type IV Monteggia fracture.

Figure 2

(a and b) Follow-up radiograph taken after 4 weeks of above-elbow plaster immobilization. Persistent dislocation of the radial head and lack of fracture healing suggest ineffective conservative management.

Figure 3

(a and b) One-year post-injury radiograph revealing chronic radial head dislocation with signs of malunion and altered elbow joint architecture, confirming the diagnosis of a neglected Monteggia fracture.

Figure 4

(a) 3D computed tomography (CT) reconstruction of the left elbow highlighting the anatomical deformity and malalignment of the radial head in multiple planes. (b) 3D-printed model based on the CT reconstruction, providing a tangible representation of the deformity used for pre-operative surgical planning.

Figure 5

(a) Intraoperative image showing surface marking of key anatomical landmarks via postero-lateral approach to the elbow. (b) Radial head excision according to pre-operative planning.

Figure 6

(a) Fluoroscopy image showing articular reduction with implant in situ. (b) Immediate post-operative anteroposterior and lateral radiographs confirming stable fixation and proper implant positioning.

Figure 7

(a and b) Clinical photograph taken at 18-month follow-up showing full range of motion and symmetric appearance of the affected elbow, with no visible deformity or discomfort.

Figure 8

(a and b) Radiograph at 18 months post-surgery confirming complete bony union at the osteotomy site and proper alignment of the radiocapitellar and u-lnohumeral joints.

Figure 9

(a and b) Post implant removal radiograph showing preserved joint congruity and anatomical alignment, supporting good long-term outcome and remodeling prior to skeletal maturity.