Complex Monteggia Fractures in the Adult Cohort: Injury and Management

Injury and Management

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


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

In This Article


Within the past 10 years, several retrospective case series have reported their outcomes of Monteggia fractures (Supplemental Table 1, Supplemental Digital Content 2,[10,34,40–42] We made several broad conclusions from the literature. First, the use of a dorsal contoured plate on the proximal ulna is nearly universal. Second, proper identification and treatment of radial head and coronoid fractures are required. Third, notable variations are observed in the outcome depending on the spectrum of injury. Owing to the heterogeneity of the patient populations, a compilation of the outcomes based on the Jupiter classification or the complexity of injury is not possible. Based on small case series and authors' narratives within the articles, the coronoid fracture, in particular, tends to be problematic. Overall, the patient with an adequately reconstructed Monteggia fracture should expect a favorable functional range of motion and outcome scores.[10,34,40–42]

Hamaker et al has the largest series with 119 patients and an average of 12 months follow-up. However, this series is quite heterogenous with 81 Bado I, 23 Bado II (and no Jupiter subclassification), seven Bado III, and eight Bado IV fractures. From their series, they reported an average flexion-extension arc from 12° to 127° and a pronosupination arc of 69° of pronation and 70° of supination. Thirty-seven patients did not achieve a functional arc of motion, and 23 required a second surgery.[34]

Shore et al[42] reported on 50 patients with various Bado type II fractures. They had an average of 16 months of follow-up, with an average flexion-extension arc from 18° to 128° and a pronosupination arc of 59° of pronation and 60° of supination. These authors also did not report any functional outcomes and had 15 complications including four infections, one recurrent dislocation, one nonunion, and five patients who required removal of hardware.

Jungbluth et al[10] have reported the most extensive cohort with patient-rated outcome measures. Their cohort included 46 patients (35 Bado II and 11 Bado I) with an average of 65 months of follow-up. Their patients range of motion was similar, with a flexion-extension arc from 8° to 133° and 86° of pronation and 82° of supination. They had four nonunions, two infections requiring surgery, and 10 patients developed HO. Unique to this series, they demonstrated good patient-reported outcomes with a Broberg and Morrey score of 86.6, DASH of 15.1, and Mayo Elbow Performance Score of 90.7.