Comminuted Monteggia fracture-dislocation--a technique for restoration of ulnar length: case reports

A technique to aid the reconstruction of the ulna in case of comminuted Monteggia fracture-dislocation is presented. This involves reducing the proximal radioulnar joint and temporarily transfixing the radial head to the ulna by 1 or 2 Kirschner (K) wires to establish the ulnar length. Once ulnar length has been defined, reconstruction of the comminuted ulna fracture is simplified. The radioulnar K-wires are then removed and the radioulnohumeral joint is tested for stability. This technique has been used in 6 cases of type-1 Monteggia fracture-dislocation with no subsequent malunion of the ulnar fracture or redislocation' of the radial head. After an average of 13 months follow-up, all patients had nearly full range of motion of the elbow joint.