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

Summary

Monteggia fractures encompass a large spectrum of injury. The severity of the injury and the complexity of the reconstruction are affected by (1) coronoid comminution, (2) radial head fracture, and (3) ulnohumeral instability. The recommended treatment is surgical stabilization with a dorsal contoured plate. A simple Monteggia fracture with minimal ulna comminution can be treated with plate fixation with indirect reduction of the radiocapitellar joint. With severe fragmentation of the coronoid, adequate fixation can be challenging, especially in cases of metaphyseal comminution at the base which can limit bone contact. Anatomic reduction of the coronoid directly affects motion and, in some cases, ulnohumeral joint stability. Although the overall surgical outcome is favorable, available case series do not delineate the difference in functional results depending on the severity of injury.

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