Chronic Monteggia.

Abstract

The chronic Monteggia may lead to pain, mobility limitation, progressive valgus deformity, lateral elbow instability, late ulnar nerve paralysis, and degenerative changes. In this review, we discuss the current procedures in the literature focused on correcting chronic Monteggia to avoid these complications. Correction of the ulnar deformity with elongation and angulation of the ulna in the opposite direction of the dislocation of the radial head is the most important factor for the reduction and consequent preservation of the radial head. This correction reestablishes the relation of the ulna with the radius and increases the space of the interosseous membrane, providing greater stability after the reduction. The correction may be performed in the acute phase and stabilized with a properly molded plate and screws, or done progressively with an external fixator. The chronic Monteggia may occur along with undiagnosed lesions, such as plastic deformation of the ulna with radial head dislocation, or after an unsuccessfully treated acute Monteggia lesion. This condition may go unnoticed, thus requiring attention to the physical examination and imaging tests. Chronic Monteggia may be treated by ulnar osteotomy with progressive correction with an external fixator. However, the most common treatment is transverse proximal ulnar osteotomy, capsulotomy and removal interposed tissue, reduction of the radial head to the capitellum and temporary transcapitellar fixation, ulnar fixation with a straight plate molded to the ulnar deformity, which is usually deviated dorsally, removal of the transcapitellar Kirschner-wire, stability test, and, if necessary, annular ligament reconstruction.