Failed Primary Fixation of Monteggia Fractures - A Case Series

Introduction: Missed lesions, myositis, nerve palsies, and compartment syndrome are the listed complications of Monteggia fracture dislocations. There is a lot of literature on missed or neglected Monteggia fractures, but we could not find any series or studies on how to tackle failed primary fixations. We report the first case series of analysis and management of failed fixation of Monteggia fractures.

In this case series, we discuss four cases that were identified as failure of fixation of the Monteggia fracture dislocation. Three children, 6-year-old female child, 7-year-old male child, 6-year-old male child, and one adult male of 39 years of age were operated on with open or closed reductions of the forearm fractures with rigid or flexible fixation. Two of these patients presented with Bado Type I, one with Type I equivalent and one Type IV fracture. In all the cases, the surgeon had correctly diagnosed the Monteggia fracture but was unable to reduce and fix it properly. We discuss the technical reasons for failure and the process by which they were corrected. After the revision surgery, the anatomy was restored in all the patients and the functional outcome was satisfactory.

Based on these cases, the authors conclude that a thorough clinical evaluation, careful pre-operative assessment of potential failure factors, and meticulous surgical planning are essential to reduce the risk of revision surgeries and prevent further complications.