Double-Modified Beltawse Reconstruction Using Pedicled Triceps Fascia and Tunneled Polypropylene Augmentation for Late-Presenting Monteggia Lesion

Abstract

Purpose: Chronic radial head instability after missed Monteggia injury remains difficult to treat when soft tissue attenuation compromises stability. This report describes a double-modified Beltawse technique combining pedicled triceps fascia reconstruction with supplemental tunneled polypropylene augmentation.

Methods: A 15-year-old male with chronic left radial head instability after a missed Monteggia fracture underwent restoration of ulnar alignment and annular ligament reconstruction. A pedicled triceps fascia strip was used in a modified Beltawse configuration. Because residual radiocapitellar subluxation persisted during intraoperative rotational testing, No. 1 polypropylene augmentation was passed circumferentially around the radial neck and secured through ulnar tunnels.

Results: After augmentation, radiocapitellar congruity was maintained throughout intraoperative flexion–extension and pronation–supination. At 1-month in-person follow-up, the elbow remained clinically stable with maintained radiocapitellar alignment on radiographs. Range of motion improved to 10° to 120° flexion–extension, 70° pronation, and 60° supination. At 7-month follow-up via video consultation, the patient reported no pain, recurrent subluxation, or symptoms suggestive of infection. Visually estimated motion was approximately 5° to 135° flexion–extension, 80° pronation, and 75° supination. DASH score improved from 61 to 12.5, and estimated Mayo Elbow Performance Score was 95. Updated radiographs could not be obtained because the patient was unable to return for in-person radiographic assessment.

Conclusions: This double-modified Beltawse technique provided satisfactory early to mid-term clinical stability in this case. Longer in-person clinical and radiographic follow-up is required to assess durability and late complications.