Recognition and fixation of crista supinatoris fractures in Monteggia injuries

In Monteggia fracture dislocations of the elbow, the lateral collateral ligament complex is disrupted as the radial head dislocates from the capitellum. A persistently incompetent lateral ulnar collateral ligament (LUCL) predisposes to posterolateral rotary instability of the elbow, thus restoration of the LUCL is essential for recovery. Although LUCL disruptions following elbow dislocations typically occur at the lateral humeral origin, we have identified a series of Monteggia injuries where the LUCL is avulsed from its ulnar insertion along with a fracture fragment containing the crista supinatoris. Failure to recognize and appropriately treat the crista supinatoris fracture in this injury may result in LUCL incompetence and risk symptomatic instability. The following technique describes the recognition and surgical treatment of Monteggia injuries, specifically recognizing the crista supinatoris fracture. Using this technique, patients reliably experience good functional outcomes with normal elbow stability.