Treatment of long-standing dislocation of the radial head in neglected monteggia fractures

Abstract

Long-standing dislocation of the radial head can result from a neglected Monteggia fracture or a congenital anomaly? Remodeling of the ulnar fracture site in Monteggia lesions can obscure the differential diagnosis from congenital dislocations of the radial head. Stability of the elbow joint depends on the congruity of the ulnohumeral joint and the ulnar collateral ligament. In the wrist joint, stability depends on the congruity of the radiocarpal joint and the palmar radiocarpal ligaments. The radiohumeral joint would thus appear to be less important than the ulnohumeral joint. However, in the extended elbow, 60% of the longitudinal forces are transmitted through the radiohumeral joint due to the carrying angle 2 (Fig. 1). Therefore, reduction of the radial head, either following a Monteggia fracture or in congenital cases, is considered very important.