Epidemiology and Treatment of Monteggia Lesion in Adults: Series of 44 Cases

Abstract

Objective: To analyze the epidemiology, treatment and outcome of a series of adult patients with Monteggia lesion treated in Uruguayan institutions. Methods: This is a retrospective article, we retrospectively identified from two Uruguayan institutions 44 adult patients with Monteggia lesion and analyzed their characteristics including Bado classification, associated injuries, treatment modality and outcome (Morrey score). Results: Using Bado classification, 23 cases (52%) were type II, 12 (27%) type I, seven (16%) type IV and two cases (5%) type III. Associated lesions were radial head fractures, found in 15 patients, coronoid ipsilateral fractures in seven patients, and neurological injuries in four. Radial head dislocation was reduced in 93% of the cases with closed maneuvers. Ulna fractures underwent open reduction and internal fixation in all 30 cases using 3.5 mm DCP plates. Complications after surgery occurred in 21 cases. Revision surgery was done in 15 cases. Outcomes after primary and revision surgery were good or excellent in 37 cases. Conclusions: In our series we observed that Monteggia lesion in adults is a serious injury with a high number of complications that often require revision surgeries. Level of Evidence IV, Retrospective Study, Case Series.

A study to assess epidemiological, clinical profile and outcome of Monteggia fracture dislocation in adults: a retrospective study

“…The present study findings were supported by another study were 84% were having excellent functional outcome which is near about similar to present study. 16 Similar findings were observed in other study too were excellent outcome was seen in 81% of the study participants.…”

Monteggia-like lesions

“…Forth, our case series revealed that Monteggia-like lesions can be associated with concomitant lateral elbow instability. This has not yet been reported in the literature, although several case series of Monteggia-like lesions can be found [16,18,32]. In our study, four cases presented lateral elbow instability intraoperatively; therefore, refixation of the lateral ligament complex with suture anchors was performed.…”

“…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].…”

“…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].…”

Unusual case of complex fracture dislocation of the elbow

“…Three main patterns of complex elbow instability have been described: posterolateral fracture dislocation, also known as the terrible triad, varus posteromedial in which anteromedial coronoid fracture with ligament complex disruption occurs, and trans-olecranon fracture dislocations [6]. Another type, ulnar diaphyseal fracture associated with radial head dislocation, is known as Monteggia fracture dislocations [10][11][12][13].…”