Monteggia and Monteggia-like-lesions: Classification, Indication, and Techniques in Operative Treatment

Abstract

Monteggia fractures consist of an ulna fracture accompanied by radial head dislocation. Such fractures are easily overlooked due to the prominence of the ulna fracture. Earlier studies have reported on the results of treating Monteggia fractures in children and adults even though this type of fracture is different in these two patient populations. As such they should be considered as separate entities due to the different injury pattern, the prognosis, and the preferred method of treatment. For a good postoperative result, an early detection of the Monteggia dislocation, an efficient operative treatment of the ulna fracture, and reposition of the radial head are essential. The goal of reconstruction is an early mobilization within a stable arc of motion. Here, we provide an overview of the classification of Monteggia fractures, the mechanism of injury, and treatment options with the aim of providing sufficient information to reduce the possibility of underestimating forearm injuries in adults.

Unusual Forearm Injury

“…However, certain variants or equivalents have also been described in relation to the fracture pattern of ulnar bone. 3 A lesion like ours with segmental ulna has not been previously described, and this is because of the peculiar mechanism of injury in our case. Nevertheless, Monteggia and its variants are associated with a combination of ulnar fracture, radiohumeral dislocation, ulnohumeral dislocation, proximal radioulnar dislocation, radial fracture and distal radioulnar joint/interosseous membrane lesion.…”

Monteggia-Frakturen und Monteggia-like Lesions

“…Über die Entstehung dieses Verletzungstypus bis bisher wenig bekannt. Es wird davon ausgegangen, dass es sich aufgrund der morphologischen Ähnlichkeit zum Typ I nach Bado mit zusätzlicher Radiusschaftfraktur um einen vergleichbaren Unfallmechanismus handelt [3].…”

“…Monteggia-Verletzungen und Monteggia-like Lesions können im mittel-und langfristigen Verlauf gute klinische Ergebnisse erreichen; die Ergebnisse sind jedoch von der Frakturmorphologie und dem Ausmaß der ligamentären Verletzungen wie auch den Weichgewebeschäden abhängig [3,17,18,28,29]. Bado-Verletzungen Typ II Jupiter A wiesen durch die Kombination von intraartikulärer Olekranonfraktur mit Koronoidfraktur und der gehäuften Assoziation mit Radiuskopffrakturen die schlechtesten funktionellen und klinischen Ergebnisse der Monteggia-Verletzungen auf [16,28].…”

“…gen (▶ Abb. 1) [1,3]. Die Luxationsrichtung des Radiuskopfes und die durch die Fraktur angulierte Ulnastellung geben die Einteilung vor.…”

Type I Monteggia fracture-dislocation in a monk from a 17th-18th century necropolis of Valladolid (Spain)

“…A common consequence in this type of fracture is the presence of evident signs of ulnohumeral arthritis (Strauss et al, 2006;Josten and Freitag, 2009). These can be seen in as a marginal osteophyte around the coronoid process of the ulna ( Figure 5, Figure 11).…”