Clinical Outcome of Acute Monteggia Fractures after Open Reduction and Internal Fixation of Ulna Alone

Hong,  In Tae; Kim,  Go Tak; Baek,  Eugene; Han,  Soo Hong

doi:2019.24.1.17

Arch Hand Microsurg > Volume 24(1); 2019 > Article

Original Article

Archives of Hand and Microsurgery 2019;24(1):17-23.
Published online March 1, 2019.
DOI: https://doi.org/10.12790/ahm.2019.24.1.17

Clinical Outcome of Acute Monteggia Fractures after Open Reduction and Internal Fixation of Ulna Alone

In Tae Hong, Go-Tak Kim, Eugene Baek, Soo-Hong Han

Department of Orthopedic Surgery, CHA Bundang Medical Center, Seongnam, Korea. hsoohong@cha.ac.kr

Received: 30 November 2018 • Revised: 8 January 2019 • Accepted: 9 January 2019

Abstract

Purpose
Most of the patients who have acute Monteggia fracture require surgical treatment. Open reduction and restoration of the alignment for the ulna, and early reduction of the radial head are the principles of treatment. The authors performed anatomic reduction and plate fixation of the ulna in acute Monteggia fractures and the aim of this study is to report the radiological and clinical results of the management.

Methods
Medical records and imaging data of 13 patients who had only internal fixation of the ulna in acute Monteggia fracture were reviewed retrospectively. The mean age was 38.8 years and average follow-up period was 23.9 months. We evaluated the range of motion, Mayo elbow performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score and complications at the last follow-up. Bone union and reduction of the radial head were reviewed by assessing serial radiographs during the follow-up.

Results
Bone union was obtained in all cases and radial heads were maintained their reduced position on the followup radiographs. The mean MEPS was 91.15 and the mean DASH score was 7.9 at the last follow-up. The mean elbow flexion was 136.5°, elbow extension was 1.2°, forearm pronation was 79°, and forearm supination was 71°. There was no specific complication during the follow-up and 3 patients had secondary surgery for plate removal by patients″ request.

Conclusion
Anatomical reduction and secure fixation of the ulnar fracture without manipulating radial head dislocation in the acute Monteggia fracture showed satisfactory outcome in this study.

Key Words: Monteggia fracture, Fracture dislocation, Fracture fixation, Open fracture reduction