Successful Strategies for Managing Monteggia Injuries

Monteggia fracture-dislocations refer to traumatic ulnar fractures associated with proximal radioulnar and radiocapitellar joint instability. Careful clinical and radiographic evaluation of the entire limb in the acutely injured child is critical for timely diagnosis and appropriate treatment. Treatment principles include restoring and maintaining both ulnar length and alignment as well as radiocapitellar joint reduction. Recent information suggests that surgical treatment of acute injuries associated with complete ulnar fractures is safe and effective in maintaining bone and joint alignment. In cases of late presentation or missed diagnoses, chronic reconstruction may be considered in symptomatic patients with preserved radiocapitellar morphology. Although challenging, ulnar osteotomy and open joint reduction with or without ligament reconstruction may restore joint congruity in the majority of patients.