Arch Hand Microsurg.  2019 Mar;24(1):17-23. 10.12790/ahm.2019.24.1.17.

Clinical Outcome of Acute Monteggia Fractures after Open Reduction and Internal Fixation of Ulna Alone

• Hong IT
• Kim GT
• Baek E
• Han SH

• KMID: 2440607
• DOI: http://doi.org/10.12790/ahm.2019.24.1.17

Abstract

PURPOSE
Most of the patients who have acute Monteggia fracture require surgical treatment. Open reduction and restoration of the alignment for the ulna, and early reduction of the radial head are the principles of treatment. The authors performed anatomic reduction and plate fixation of the ulna in acute Monteggia fractures and the aim of this study is to report the radiological and clinical results of the management.
METHODS
Medical records and imaging data of 13 patients who had only internal fixation of the ulna in acute Monteggia fracture were reviewed retrospectively. The mean age was 38.8 years and average follow-up period was 23.9 months. We evaluated the range of motion, Mayo elbow performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score and complications at the last follow-up. Bone union and reduction of the radial head were reviewed by assessing serial radiographs during the follow-up.
RESULTS
Bone union was obtained in all cases and radial heads were maintained their reduced position on the followup radiographs. The mean MEPS was 91.15 and the mean DASH score was 7.9 at the last follow-up. The mean elbow flexion was 136.5°, elbow extension was 1.2°, forearm pronation was 79°, and forearm supination was 71°. There was no specific complication during the follow-up and 3 patients had secondary surgery for plate removal by patients"³ request.
CONCLUSION
Anatomical reduction and secure fixation of the ulnar fracture without manipulating radial head dislocation in the acute Monteggia fracture showed satisfactory outcome in this study.

Keyword

Monteggia fracture; Fracture dislocation; Fracture fixation; Open fracture reduction

MeSH Terms

Arm
Dislocations
Elbow
Follow-Up Studies
Forearm
Fracture Fixation
Hand
Head
Humans
Medical Records
Monteggia's Fracture
Pronation
Range of Motion, Articular
Retrospective Studies
Shoulder
Supination
Ulna*

Figure

• 

  Fig. 1. A 35-year-old female with Bado type I Monteggia fracture of the right forearm after pedestrian traffic accident. (A) Preoperative radiologic finding shows type I Monteggia fracture. X-ray shows anterior dislocation of radial head and angulation of ulnar metaphysical fracture. Postoperative X-ray finding showed good alignment of ulna and radial head reduction. (B) At the final follow-up, and the range of motion was 5° to 140°, and satisfactory results were obtained.

• 

  Fig. 2. A 30-year-old female with Bado type III Monteggia fracture of the right forearm after slip and fall injury. (A) Preoperative radiologic finding shows type III Monteggia fracture. X-ray shows lateral dislocation of radial head and posterior angulation of ulnar metaphysical fracture. In this case, using olecranon plate ulna and radial head reduction was done. (B) There was no pain at the final follow-up, and the range of motion was 0° to 150° and satisfactory results were obtained.

Reference

1.Trillat A., Marsan C., Lapeyre B. [Classification and treatment of Monteggia fractures. Apropos of 36 cases]. Rev Chir Orthop Reparatrice Appar Mot. 1969. 55:639–57. French.

2.Korner J., Hoffmann A., Rudig L, et al. [Monteggia injuries in adults: critical analysis of injury pattern, management, and results]. Unfallchirurg. 2004. 107:1026–40. German.

3.Ring D., Jupiter JB., Simpson NS. Monteggia fractures in adults. J Bone Joint Surg Am. 1998. 80:1733–44.

4.Ring D. Monteggia fractures. Orthop Clin North Am. 2013. 44:59–66.

5.Bado JL. The Monteggia lesion. Clin Orthop Relat Res. 1967. 50:71–86.

6.Bruce HE., Harvey JP., Wilson JC Jr. Monteggia fractures. J Bone Joint Surg Am. 1974. 56:1563–76.

7.Bae DS. Successful strategies for managing Monteggia injuries. J Pediatr Orthop. 2016. 36(Suppl 1):S67–70.

8.Ozel O., Demircay E. Review of management of unstable elbow fractures. World J Orthop. 2016. 7:50–4.

9.Stein F., Grabias SL., Deffer PA. Nerve injuries com-plicating Monteggia lesions. J Bone Joint Surg Am. 1971. 53:1432–6.

10.Myden C., Hildebrand K. Elbow joint contracture after traumatic injury. J Shoulder Elbow Surg. 2011. 20:39–44.

11.Shamian B., Capo JT. Isolated radial shaft fracture with unreducable posterior dislocation of the radial head and rupture of the lateral collateral ligament: a case report. J Clin Orthop Trauma. 2012. 3:126–9.

12.Tanner C., Johnson T., Kolahi K., Husak L., Hoekzema N. Irreducible Monteggia fracture: interposed radial nerve and capsule. JSES Open Access. 2017. 1:85–9.

13.Soubeyrand M., Lafont C., De Georges R., Dumontier C. [Traumatic pathology of antibrachial interosseous mem-brane of forearm]. Chir Main. 2007. 26:255–77. French.

14.Suarez R., Barquet A., Fresco R. Epidemiology and treatment of Monteggia lesion in adults: series of 44 cases. Acta Ortop Bras. 2016. 24:48–51.

15.Reynders P., De Groote W., Rondia J., Govaerts K., Stoffelen D., Broos PL. Monteggia lesions in adults. A multicenter Bota study. Acta Orthop Belg. 1996. 62(Suppl 1):78–83.

16.Müller ME., Allgöwer M., Schneider R., Willenegger H. Manual of internal fixation: techniques recommended by the AO-ASIF Group. 3rd ed.New York: Springer;1991.