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Original Article Surgical Outcomes of the Monteggia Type 2 Fracture Dislocation in Adults
Sung Choi, Daegeun Jeong, Youngsoo Byun, Taehoe Gu, Sungsoo Ha, Dongju Shin
Journal of Musculoskeletal Trauma 2019;32(1):6-13.
DOI: https://doi.org/10.12671/jkfs.2019.32.1.6
Published online: January 31, 2019
1Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea. osaabga@gmail.com
2Department of Orthopaedic Surgery, Gyeongsan Joongang Hospital, Gyeongsan, Korea.

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Abstract

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 107° (70°–130°) and the mean MEPS was 89 (45–100). 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.


J Korean Fract Soc. 2019 Jan;32(1):6-13. Korean.
Published online Jan 25, 2019.
https://doi.org/10.12671/jkfs.2019.32.1.6
Copyright © 2019 The Korean Fracture Society. All rights reserved.
Original Article

Surgical Outcomes of the Monteggia Type 2 Fracture Dislocation in Adults

Sung Choi, M.D., Daegeun Jeong, M.D.,* Youngsoo Byun, M.D., Ph.D., Taehoe Gu, M.D., Sungsoo Ha, M.D. and Dongju Shin, M.D., M.S.
    • Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea.
    • *Department of Orthopaedic Surgery, Gyeongsan Joongang Hospital, Gyeongsan, Korea.
  • Correspondence to: Dongju Shin, M.D., M.S. Department of Orthopaedic Surgery, Daegu Fatima Hospital, 99 Ayang-ro, Dong-gu, Daegu 41199, Korea. Tel: +82-53-940-7324, Fax: +82-53-954-7417, Email: osaabga@gmail.com
Received June 09, 2018; Revised September 03, 2018; Accepted October 05, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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 107° (70°–130°) and the mean MEPS was 89 (45–100). 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.

Keywords
Elbow, Ulna, Radius, Olecranon process, Monteggia's fracture, Fracture dislocation

Figures

Fig. 1
A 66-year-old woman fell on the ground and injured her left elbow (Jupiter's Type 2A fracture dislocation associated with a radial head fracture and coronoid process fracture). (A) Initial anteroposterior. (B) Initial lateral view. (C, D) Three-dimensional computed tomography. (E) Anteroposterior view 32 months after the open reduction and internal fixation of ulna, replacement of the radial head and repair of medial collateral ligament & lateral collateral ligament. (F) Lateral view 32 months after surgery. (G) On the last follow-up, 32 months after surgery, range of motion=10°–125°, Mayo elbow performance score=100 (excellent).

Fig. 2
A 39-year-old woman fell from a height and injured her left elbow (Jupiter's Type 2C fracture dislocation associated with radial head fracture). (A) Initial anteroposterior & lateral views. (B) Postoperative anteroposterior & lateral views after open reduction and internal fixation & radial head excision. (C) Metal failure 3 months after surgery. (D) Postoperative anteroposterior & lateral views after 2nd surgery. On the last follow-up at 57 months after 2nd surgery, range of motion=20°–100°, Mayo elbow performance score=75 (good) with elbow instability.

Fig. 3
A 22-year-old woman fell from a height and injured her right elbow (Jupiter's Type 2D fracture dislocation associated with the radial head fracture and coronoid process fracture). (A) Initial lateral view. (B) Postoperative lateral view. (C) Lateral view 3 weeks after surgery (instability of elbow joint). (D) Postoperative lateral view after the 2nd surgery (additional plate fixation at coronoid process). (E) Radioulnar synostosis 18 months after the 2nd surgery. (F) Postoperative anteroposterior view after the 3rd surgery (ostectomy & partial implant removal). On the last follow-up of 25 months after the first surgery and range of motion=10°–120°, Mayo elbow performance score=95 (excellent).

Fig. 4
A 40-year-old man injured by a motor cycle traffic accident and injured his right elbow (Jupiter's Type 2C fracture dislocation associated with lateral ulnar collateral ligament rupture). (A) Initial anteroposterior & lateral views. (B) Postoperative anteroposterior & lateral views after open reduction and internal fixation. (C) Elbow instability 9 days after surgery. (D) Reconstruction of the lateral ulnar collateral ligament with palmaris longus tendon & postoperative anteroposterior & lateral views after 2nd surgery. On the last follow-up 34 months after the 2nd surgery, range of motion=20°–126°, Mayo elbow performance score=100 (excellent).

Tables

Table 1
Demographics of the Patients

Table 2
Jupiter's Subclassification

Notes

Financial support:None.

Conflict of interests:None.

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    Surgical Outcomes of the Monteggia Type 2 Fracture Dislocation in Adults
    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
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