Complex Monteggia Fractures in the Adult Cohort: Injury and Management

Injury and Management

Jaehon M. Kim, MD; Daniel A. London, MD, MS

Disclosures

J Am Acad Orthop Surg. 2020;28(19):e839-e848. 

In This Article

Abstract and Introduction

Abstract

Monteggia fractures involve proximal ulna fracture associated with a radiocapitellar joint dislocation. The Bado classification is primarily based on the direction of the radial head dislocation. The Jupiter subtype classification of Bado II fractures further characterizes the severity of proximal ulna comminution and the involvement of the coronoid fragment. This latter classification can better prognosticate the challenges of surgical reconstruction and clinical outcomes. Surgery for all adult Monteggia fractures is required to restore the anatomic alignment of the ulna, which indirectly reduces the radiocapitellar joint. The complexity of the injury is considerably increased by comminution of the proximal ulna, the degree of radial head fragmentation, the reduction of the radial head, and ulnohumeral instability. Anatomic reduction is considered critical to achieving a favorable outcome.

Introduction

Monteggia fractures classically involve a proximal third ulna fracture associated with a radiocapitellar joint dislocation. These injuries were first defined by Dr. Giovanni Battista Monteggia in 1814 and later were eponymously named Monteggia fractures by Dr. Jules Perrin.[1] Monteggia fractures include a wide spectrum of patterns, which makes the literature comparisons challenging. In addition to the two primary criteria of Monteggia fractures, there is a notable variation in injury patterns, including radial head fractures, coronoid fractures, and ulnohumeral instability. The identification of these injuries is essential for proper treatment.

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