Monteggia-like lesions - treatment strategies and one-year results

The eponym "Monteggia fracture" includes various patterns of complex fracture-dislocations of the proximal ulna and radius, which are not well defined yet. They are frequently described as Monteggia-like lesions or Monteggia equivalent injuries. Until today, these injury patterns have been reported rarely. The objective of this retrospective study was to better define patterns of injury and to document the short-term results of treatment with current fixation techniques.

Ten patients with a Monteggia-like lesion were included in this study and clinical and radiological follow-up examinations at an average of 12.3 months after the trauma were performed. For clinical follow-up the Mayo Modified Wrist Score, the Mayo Elbow Performance Score, the functional rating index of Broberg and Morrey, and the DASH score were utilized.

Osteosynthesis of the ulna was performed using a proximally contoured or precontoured LCP (locking compression plate) in all patients. All patients had a fracture of the radial head. All patients with a Mason type III radial head fracture received a cemented bipolar radial head prosthesis. All Mason type II fractures were treated with open reduction and internal fixation using mini screws. In all Mason type I fractures the treatment of the radial head dislocation was by closed reduction. Associated coronoid fractures were stabilized with lag screws through the ulnar plate or with independent lag screws after reduction of the fracture. According to the aforementioned scoring systems good to excellent results could be achieved.

Our findings demonstrate that good or excellent short-term results can be obtained if the injury is classified correctly and a standardized surgical treatment of all components of the injury is achieved. Further studies with larger patient populations and longer follow up periods are needed to evaluate long-term effectiveness of this treatment concept.