Journal of Musculoskeletal Trauma

Surgical Outcomes of the Monteggia Type 2 Fracture Dislocation in Adults: Sung Choi, Daegeun Jeong, Youngsoo Byun, Taehoe Gu, Sungsoo Ha, Dongju Shin; J Korean Fract Soc 2019;32(1):6-13. Published online January 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.1.6

Abstract PDF: PURPOSE
This study examined clinical outcomes of Monteggia fracture type 2, which is the most common in adults with a high rate of accompanied injuries.
MATERIALS AND METHODS
From June 2004 to November 2015, a retrospective study was performed on 12 patients diagnosed with Monteggia fracture type 2 with a follow-up period of at least 6 months after surgery. The clinical outcomes were evaluated using the Mayo elbow performance score (MEPS), and the existence of accompanied injures, radiological result, and complications were analyzed.
RESULTS
Posterior instability was confirmed in all patients and accompanied fractures were detected in 9 patients (75.0%) on the radial head, whereas 10 patients (83.3%) were found on the coronoid process. The average arc of motion was 107Â° (70Â°â€“130Â°) and the mean MEPS was 89 (45â€“100). Additional re-operation due to re-dislocation, radioulnar synostosis, elbow instability, ulna nonunion, and radial head nonunion were performed in 4 cases (33.3%).
CONCLUSION
The Monteggia fracture type 2 is more commonly associated with radial head fractures and coronoid process fractures rather than other types, which causes elbow instability. Because the rate of additional surgery due to complications is high, the treatment of Monteggia fracture type 2 requires careful assessments.

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Missed Variation of the Essex-Lopresti Injury Associated with Type-I Monteggia Equivalent Lesion: A Case Report: Young Sung Kim, Phil Hyun Chung, Suk Kang, Ho Min Lee, Jong Pil Kim; J Korean Fract Soc 2012;25(3):219-222. Published online July 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.3.219

Abstract PDF: The authors report the case of a patient with the combination of a Type I Monteggia equivalent lesion and Essex-Lopresti injury. This combination of injury is very rare, and an associated distal radioulnar injury is often missed. We hope our experience illustrates the need to examine the wrist joint carefully and to be aware of the potential for distal radioulnar joint instability in all patients with type I Monteggia equivalent lesions.

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Factors Affecting the Functional Result of Monteggia Fractures in Adults: Yong Bum Park, Byeong Ki Lee, Kwang Won Lee, Whoan Jeang Kim, Ha Yong Kim, Jae Hoon Ahn, Won Sik Choy; J Korean Soc Fract 2000;13(3):597-604. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.597

PURPOSE
Monteggia fracture is a combination of ulnar fracture and radial head dislocation. Despite of low incidence, Monteggia fracture has a problem in the treatment. So satisfactory results could not be achieved easily. The purpose of this study was to analyze factors affecting functional results in Monteggia fracture.
MATERIALS AND METHODS
From January 1990 to June 1998, we retrospectively reviewed 24 patients out of 40 patients who had been treated for Monteggia fracture. The functional assessment was performed with Broberg and Morrey system10).
RESULTS
Excellent and good results were achieved in 16 cases(66.6%), whereas fair and poor results in 8 cases(33.4%). Satisfactory results were obtained in 66.6% overall. According to the Bado classification, functional results were not different significantly between types. According to the mechanisms of injury, unsatisfactory results were obtained in 8 of 17 patients with high energy injury. Monteggia fractures with ulnar fracture at the diaphyseal level showed satisfactory results significantly compared to others. In terms of the methods of internal fixation, the plate and screw fixation showed satisfactory results in 14 of 16 patients whereas tension band wiring or intramedullary nailing showed unsatisfactory results in 6 of 8 patients.
CONCLUSION
In Monteggia fractures, factors affecting functional result may be the mechanism of injury, the level of ulnar fracture and the method of internal fixation.

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Incomplete Anterior Interosseous Nerve Palsy That Accompanied a Monteggia Fracture
Bo-Kyu Yang, Seong-Wan Kim, Seung-Rim Yi, Young-Jun Ahn, Jung-Ho Noh, Young-Hak Roh, Seung-Won Lee, Min-Soo Je, Seok-Jin Kim
Journal of the Korean Orthopaedic Association.2011; 46(1): 78. CrossRef

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Nerve injuries complicating Monteggia lesion: Jae Duk Ryu, Chang Hwan Han, Weon Yoo Kim, Jin Hyung Sung, Jin Ho Jung, Jin Young Kim; J Korean Soc Fract 2000;13(3):591-596. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.591

Abstract PDF: PURPOSE
Concerns on the Monteggia lesion was concentrated on the injuries to the bone parts and largely ignores the soft tissues and the nerves in particular. We reviewed injured nerve, treatment and prognosis in the Monteggia lesion associated with nerve injury.
MATERIALS AND METHODS
From January 1990 through November 1999, 26 patients with Monteggia lesions have been treated: six of these patients had associated with nerve injuries. The age of injured patients ranged from 9 to 67 years with an average of 25.5 years.
RESULTS
All could be classified as Type 1 of Bado(anterior dislocation of the radial head), and four injuries were open and two were closed. two patients had radial-nerve palsy and four patients had posterior interosseous-nerve palsy, one of them with associated ulnar-nerve palsy. The fifth patient demonstrated complete spontaneous recovery. One patient with posterior interosseous nerve injury was absence of spontaneous return of function within 12 weeks after injury, exploration and neurolysis was performed. Complete recovery of posterior interosseous nerve function occurred in 14 weeks after exploration.
CONCLUSION
Monteggia lesions can be reduced early with ease under general anesthesia and, if necessary, even under local anesthesia. Spontaneous recovery of nerve function may occur within 12 weeks; in the absence of electromyographic or clinical evidence of return of nerve function within 12 weeks, exploration and neurolysis is indicated.

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The Combined Operative Treatment for Neglected Monteggia Fracture-Dislocation in Adolescent Period: Report of 2 cases: Churl Hong Chun, Sang Soo Kim, Jeong Min Yoo; J Korean Soc Fract 1998;11(4):964-969. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.964

Abstract PDF: There are various perative methods for the treatment of neglected Monteggia fracture-dislocation. ut, it is difficult to obtain good results by the onlyone operative method in the adolescent period. We reported two patients for the neglected Monteggia fracture-dislocation in adolescent period who were treated by the combined operative treatment. The combined operative method was, in regular sequence, the ulnar osteotomy, the fibrous tissus removed in the humeroradial joint, radial head reduction, Bell-Tawse annular-ligament reconstruction and fixating the radial head to the capitellum with the K-wire with neutral position. Finally, plate fixation in ulnar osteotomy site was done. After 3 weeks, we removed the K-wire and performed active ROM exercise. The clinical results were evaluated by Bruce scale at the follow-up 15 months and 53 months. The results were satisfactory without complications. So we canvass for this combined method about neglected Monteggia fracture-dislocation in adolescent period.

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Ipsilateral Monteggia Fracture and Lateral Condyle fracture of Humerus in Children: Jung Ho Park, Seung Woo Suh; J Korean Soc Fract 1997;10(3):708-711. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.708

Abstract PDF: Authors experienced a rare injury in a 5-year-old girl with Monteggia fracture and concomitant lateral condyle fracture of humerus with radial nerve injury. This combined injury has not been reported in the literature. This unusual fractures were treated by open reduction and K-wire fixation of lateral condyle fracture and transcapitellar K-wire fixation of radial head dislocation. An excellent result was obtained with operative treatment.

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Treatment of Monteggia fracture in Adults: Dong Min Shin, Byung Ho Lee, Hyun Jung Yoon; J Korean Soc Fract 1994;7(1):79-86. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.79

Abstract PDF: In 1814 Monteggia described two cases of fracture of the proximal part of the ulna with anterior dislocation of the radial head. Since then, there have been many reports of this type of fracture dislocation. Bado named Monteggia lesion as a fracture of ulna at any level and a dislocation of radial head. Thrity-five patient with Monteggia fracture were treated at department of Orthopaedic Surgery, Ehosun University Hospital from 1985. January to 1991 December. Twenty-seven patient, who were followed for a minimum of one year, subject of this review. The results were as follows: 1. Among the 27 patients, male is about 3 times more than female. 2. The cause of injuries were traffic accident in 15, fall down in 10, belt injury in 1 and direct blowing in 1 3. Classification into 4 type by Bados method disclosed that type I accounts for 51.9% of cases, type II for 14.8%, type III for 22.8% and type IV for 11.1% 4. Sites of ulna fractures were upper one thlrd in 8, junction of upper and middle 1/3 in 11, middle 1/3 in 5, distal 1/3 in 1 and segmental 2. 5. Closed reduction of radial head dislocation was done in 13 cases open reduction in 6 cases, and excision in 8 cases. 6. All of the fractures of ulna were treated with open reduction and internal fixation with plate in 16, Rush pin in 6 and wiring in 5. 7. The partial posterior interosseous nerve injury was noticed in 3 cases and recovered completely within 8 weeks. 8. With the criteria of Bruce et al(1974), the result were excellent in 11, good in 7, fair in 5 and poor in 4.

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Clinical Study on Monteggia fracture in Adults: Hyung Ku Yoon, Kwang Pyo Jeon, Kuk Whan Oh, Dae Eun Jung, Kyung Hoon Kang, Nam Kil Cho; J Korean Soc Fract 1994;7(1):29-36. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.29

Abstract PDF: In 1814, Monteggia first desHribed a fracture of proximal third of the ulna with dislocation of radial head, and Bado classified and included all fracture of ulna at any level with a dislocation of radial head under the name of Monteggla lesion In 1967. In adults, the prognosis Is poor due to many complications such as nerve injury, unreduced radial head, heterotrophic ossification, nonunion and malunion. The most important factors In achieving good results in adult Monteggia lesions are early accurate diagnosis, rigid internal fixation of the ulna and complete reduction of the radial head as soon as possible. The authors reviewed 12 cases of Monteggia fracture In adults who were treatod at department of orthopaedic surgery, Sung-Ae General hospital from 1989 jan. to 1991 Dec. with 17 months mean follow-up. The results obtained were as follows: 1. Male was 10 cases and female 2 cases. 2. The causes of injury were traffic accident In 9 cases, machinery injury in 2, fall down in 1 3. Location of ulna fracture was as follows; metaphysis was 4, proximal 1/3 in 6 cases, proximal 1/3 junction in 1, metaphysls and proximal 1/3 in 1. 4. According to Bado classificatlon, type I was 58%. type II 25%, tyre III 17%, type IV 0%. 5. Treatments of dislocated radial head were closed reduction in 9 Gases open reduction in 1 case, and excision in 2 cases. 6. Fractures of ulna were all treated with open reduction and internal fixation with plate in 9 cases. IM nailing in 1 case, tension band wiring in 2 cases. 7. Palsy of posterior interosseous nerve was in 2 cases with complete recovery within 6 months. 8. The results(Bruce, et. at) 17 month follow-up in average were 2 excellent, 5 good, 2 fair and 3 poor.

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Monteggia fracture in children 6 cases report: Young Ill Kim, Hyung Duk You; J Korean Soc Fract 1992;5(1):103-110. Published online May 31, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.1.103

Abstract PDF: No abstract available.

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