Clinical-Radiological Dissociation after Failed Monteggia Fixation: Preserved Function at 2 Years Despite Proximal...

Monteggia fracture-dislocations in adults require restoration of ulnar length and alignment to maintain radiocapitellar stability. Fixation failure with refracture and recurrent radial head dislocation is typically managed surgically.

A 42-year-old right-hand dominant male electrician sustained a fall on level ground and presented with pain and swelling around the left elbow and proximal forearm and an inability to mobilize the elbow. He had undergone open reduction and internal fixation for a Monteggia injury 2 years prior. Radiographs demonstrated breakage of an anatomical olecranon plate with refracture at the proximal ulna and lateral radial head dislocation. After swelling subsided, implant removal was performed. Periosteal reaction around the proximal ulna and distal humerus raised concern for infection; however, no intraoperative purulence was seen, and cultures were negative. Definitive reconstruction was advised, but the patient refused repeat surgery and was lost to follow-up. At 2 years follow-up, radiographs showed persistent proximal ulnar fibrous non-union and chronic lateral radial head dislocation; clinically, he had minimal pain, preserved functional elbow motion, Mayo Elbow Performance Score 90, and QuickDASH 4.5/100.

This case highlights clinical-radiological dissociation after failed Monteggia fixation. While surgical reconstruction remains standard, selected patients with minimal pain, clinically stable fibrous non-union, and acceptable function, especially with informed refusal of surgery, may be managed with careful observation and counseling regarding potential late deterioration.