Monteggia fractures in adults:Review of 48 cases

Abstract

Objective To review the surgical treatment outcomes of Monteggia fractures in adults. Methods From September 1994 to January 2007, 48 patients with Monteggia fracture were treated in our hospital. The average age was 36.4 years ( 18 -66 years). According to the classification of Bado, there were 22 cases of type Ⅰ, 17 cases of type Ⅱ, 6 cases of type. Ⅲ and 3 cases of type Ⅳ fractures. In 54.2% of the patients, the lesions were associated with multiple traumas. Eight cases had radial/median/ulnar nerve injuries. In 44 cases, treatment consisted of open reduction or osteotomy and internal fixation of the ulnar fracture using different methods of ostcosynthesis (3.5 mm DCP, 3.5 mm reconstruction plates, tension band technique with Kirschner wires, and one-third tubular plates). Initial treatment of the radial head dislocation was attempted by closed reduction under fluoroscopy monitoring. Subsequent open reduction was performed in 37 cases after failed close reduction. Four of these cases underwent annular ligament repair or reconstruction. Four had partial or complete resection of the radial head. There were seven open fractures with one case developing chronic infection. Results The average foLlow-up was 17 months (6 -26 months). At the most recent follow-up examination, the average score, according to the system of Broberg and Money, was 84.2 points (range, 31 to 100 points). The result was excellent for 17 patients, good for 15, fair for 9, and poor for 7. Nine of the 16 patients who had an unsatisfactory (fair or poor) result had had a Bado type-Ⅱ fracture with a concomitant fracture of the radial head. Recovery of hand function was observed in 8 cases that had concomitant nerve injury and 6 cases that suffered nerve injury due to close reduction. Conclusion Monteggia fractures in adults are fraught with compheations despite good functional results in the majority of cases. The patient should be informed early on of the risks of residual functional deficits and the need for further surgical intervention.