Monteggia fractures and the Bado CLASSIFICATION: AN urban trauma center experience

There are conflicting reports regarding the incidence of Monteggia fractures by Bado type and their associated risks of nerve and vascular injury and other complications.

A registry was queried at a level I trauma center for Monteggia fracture codes. A retrospective chart and radiographic review were then conducted to correctly identify Monteggia fractures. The primary outcome was incidence by Bado type with secondary outcomes being associated injuries.

69 patients sustained Bado I (42), Bado II (15), Bado III (8), and Bado IV (4) injuries. 83 % had a high-energy mechanism. 7 % had vascular injuries, 32 % were open, 13 % had a radial head fracture, 10 % had neurological deficits, 0 % had compartment syndrome, 1 % required open reduction of the radiocapitellar joint, 1 % developed malunion, and 9 % developed nonunion. 61 % were Bado I injuries. However, it was more common for Bado III fractures to be open (p = 0.018), and for Bado II fractures to involve radial head fractures (p = 0.008). Neurologic deficits were seen in Bado I, II, and IV injuries with 5/7 of these injuries in Bado I patients, although not significant (p = 0.600). Three nerve injuries were transections without recovery. Five vascular injuries were seen, none required revascularization. One Bado I required open reduction of the radiocapitellar dislocation. Malunion and nonunion were significant for Bado II (p = 0.031).

Bado I are the most common type in this mostly high-energy cohort. There were no significant differences in the incidence of associated neurologic or vascular injuries between Bado types. There were significantly more nonunion/malunion and radial head fractures in Bado II and greater percentage of open injuries in Bado III. No patients developed compartment syndrome. Twelve patients had nerve or vascular injuries, 32 % were open fractures, and 6 had nonunions, underscoring that this is not a benign injury.