Monteggia fractures in adults

Abstract

The objective of this retrospective study was to correlate the Bado and Jupiter classifications with long-term results after operative treatment of Monteggia fractures in adults and to determine prognostic factors for functional outcome. Of 63 adult patients who sustained a Monteggia fracture in a ten-year period, 47 were available for follow-up after a mean time of 8.4 years (5 to 14). According to the Broberg and Morrey elbow scale, 22 patients (47%) had excellent, 12 (26%) good, nine (19%) fair and four (8%) poor results at the last follow-up. A total of 12 patients (26%) needed a second operation within 12 months of the initial operation. The mean Broberg and Morrey score was 87.2 (45 to 100) and the mean DASH score was 17.4 (0 to 70). There was a significant correlation between the two scores (p = 0.01). The following factors were found to be correlated with a poor clinical outcome: Bado type II fracture, Jupiter type IIa fracture, fracture of the radial head, coronoid fracture, and complications requiring further surgery. Bado type II Monteggia fractures, and within this group, Jupiter type IIa fractures, are frequently associated with fractures of the radial head and the coronoid process, and should be considered as negative prognostic factors for functional long-term outcome. Patients with these types of fracture should be informed about the potential risk of functional deficits and the possible need for further surgery.

Divergent elbow dislocation with radial shaft fracture, distal ulnar deformation, and distal radioulnar joint instability: an unclassifiable Monteggia variant

“…The displacement by muscle forces across the fracture site and associated ligamentous injury has been shown to be a source of significant morbidity in the past, especially before the routine use of contoured compression plates for treatment [10, 11]. Bado type II and injuries with associated radial head and coronoid fractures have historically portended poor clinical outcomes [3]. Potential complications of Monteggia fractures include persistent dislocation of the radial head, elbow stiffness, forearm synostosis, nerve palsy, and residual forearm deformity [12].…”

Monteggia-like lesions

“…Several other authors also observed the predominance of Bado type II fractures in adults [8,16,22,23,29], while in children and in cases of high-energy trauma, Bado type I injuries are more common [28,32]. Bado type I lesions show excellent or good functional outcomes in most cases, probably due to a low incidence of concomitant fractures of the radial head or the coronoid process [16,28,32]. In contrast, Bado type II lesions are reported to show significantly poorer outcomes [16,26,28].…”

“…Bado type I lesions show excellent or good functional outcomes in most cases, probably due to a low incidence of concomitant fractures of the radial head or the coronoid process [16,28,32]. In contrast, Bado type II lesions are reported to show significantly poorer outcomes [16,26,28]. Fractures of the radial head or the coronoid process have been reported to correlate with poor functional outcome scores and occur more frequently in older patients with associated bone weakness [16,32].…”

“…In contrast, Bado type II lesions are reported to show significantly poorer outcomes [16,26,28]. Fractures of the radial head or the coronoid process have been reported to correlate with poor functional outcome scores and occur more frequently in older patients with associated bone weakness [16,32]. Konrad et al described Bado type IIa and IId lesions as negative prognostic factors [16].…”

Comminuted radial head fractures: aspects of current management

“…37,64 These fractures, unlike proximal radial shaft fractures, are thought to confer a worse prognosis. 40 Proximal ulnar fractures occurring in association with a fractured radial head should be fixed to provide a stable posterior column. Because comminuted radial head fractures are usually secondary to a high-energy injury, associated ulnar fractures tend to have multiple fragments rather than be simply transverse or oblique.…”