Abstract
Monteggia fractures consist of an ulna fracture accompanied by radial head dislocation. Such fractures are easily overlooked due to the prominence of the ulna fracture. Earlier studies have reported on the results of treating Monteggia fractures in children and adults even though this type of fracture is different in these two patient populations. As such they should be considered as separate entities due to the different injury pattern, the prognosis, and the preferred method of treatment. For a good postoperative result, an early detection of the Monteggia dislocation, an efficient operative treatment of the ulna fracture, and reposition of the radial head are essential. The goal of reconstruction is an early mobilization within a stable arc of motion. Here, we provide an overview of the classification of Monteggia fractures, the mechanism of injury, and treatment options with the aim of providing sufficient information to reduce the possibility of underestimating forearm injuries in adults.
Similar content being viewed by others
References
Monteggia GB. Instituzioni chirurgische. Milan: Maspero, 1814.
Korner J, Lill H, Josten C. Monteggiaverletzungen. In: Josten C, Lill H, eds. Ellenbogenverletzungen. Darmstadt: Steinkopff, Darmstadt, 2002:123–36.
Konrad GG, Kundel K, Kreuz PC, Oberst M, Sudkamp NP. Monteggia fractures in adults: long-term results and prognostic factors. J Bone Joint Surg 2007;89B:354–60.
Korner J, Hoffmann A, Rudig L, Müller LP, Hessmann M, Lill H, Josten C, Rommens PM. Monteggia injuries in adults: critical analysis of injury pattern, management and results. Unfallchirurg 2004;11:1026–40.
Egol KA, Tejwani NC, Bazzi J, Susarla A, Koval KJ. Does Monteggia variant lesion result in a poor functional outcome? A retrospective study. Clin Orthop Relat Res 2005;438:233–8.
Reynders P, De Groote W, Rondia J. Monteggia lesions in adults: a multicentre Bota study. Acta Orthop Belg 1996;62:78–83.
Givon U, Pritsch M, Levy O. Monteggia and equivalent lesions: a study of 41 cases. Clin Orthop 1997;337:208–15.
Llusa Perez M, Lamas C, Martinez I, Pidemunt G, Mir X. Monteggia fractures in adults: review of 54 cases. Chir Main 2002;21:293–7.
Strauss EJ, Tejwani NC, Preston CF, Egol KA. The posterior Monteggia lesion with associated ulnohumeral instability. J Bone Surg 2006;88B:84–9.
Bruce HE, Hrvey JP, Wilson JCJr. Monteggia fractures. J Bone Joint Surg 1974;56A:1563–76.
Bado JL. The Monteggia lesion. Clin Orthop 1967;50:71–86.
Jupiter JB, Leibovic SJ, Ribbans W, Wilk R. The posterior Monteggia lesion. J Orthop Trauma 1991;5:395–402.
Tompkins DG. The anterior Monteggia fracture. Observations on etiology and treatment. J Bone Joint Surg 1971;53A:1109–14.
Penrose JH. The Monteggia fracture with posterior dislocation of the radial head. J Bone Joint Surg 1951;33B:65–73.
Mullick S. The lateral Monteggia fracture. J Bone Joint Surg 1977;59A:543–5.
Ring D, Jupiter JB, Simpson NS. Monteggia fractures in adults. J Bone Joint Surg 1998;80A:1733–44.
McKee MD, Jupiter JB. Trauma to the adult elbow and fractures of the distal humerus. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal trauma. Philadelphia: Saunders, 1998;1455–69.
Morrey B, ed. The elbow and its disorders, 2nd edn. Philadelphia: Saunders, 1993.
Korner H, Diederichs G, Arzdorf M, Lill H, Josten C, Schneider E, Linke B. A biomechanical evaluation of methods of distal humerus fracture fixation using locking compression plates versus conventional reconstruction plates. J Orthop Trauma 2004;18:286–93.
Korner J, Lill H, Muller LP, Rommens PM, Schneider E, Linke B. The LCP concept in the operative treatment of distal humerus fractures-biological, biomechanical and surgical aspects. Injury 2003;34:B20–30.
Grechenig W, Clement H, Pichler W, Tesch NP, Windisch G. The influence of lateral and anterior angulation of the proximal ulna on the treatment of a Monteggia fracture: an anatomical cadaver study. J Bone Surg 2007;89B:836–8.
Korner J, Lill H, Josten C. Olekranonfraktur. In: Josten C, Lill H, eds. Ellenbogenverletzungen. Darmstadt: Steinkopff, 2002; 151–62.
Rommens PM, Küchle R, Schneider RU, Reuter M. Olecranon fractures in adults: factors influencing outcome. Injury 2004;35:1149–57.
Pavel A, Pitman JM, Lance EM, Wade PA. The posterior Monteggia fracture. A clinical study. J Trauma 1965;5:185–199.
Lill, H, Korner J, Josten C. Luxationen und Instabilitäten In: Josten C, Lill H, eds. Ellenbogenverletzungen. Darmstadt: Steinkopff, 2002;118–21.
Nestor BJ, O’Discroll SW, Morrey BF. Ligamentous reconstruction in posterolateral rotatory instability of the elbow. J Bone Joint Surg 1992;74A:1235–41.
Josten C, Korner J, Lill H. Radiusköpfchenfrakturen. In: Josten Ch, Lill H, eds. Ellenbogenverletzungen. Darmstadt: Steinkopff, 2002;137–49.
O’Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the elbow. J Bone Joint Surg 1991;73A:440–6.
Regan WD, Morrey BF. Fractures of the coronoid process of the ulna. J Bone Joint Surg 1989;71A:1348–54.
Cohen MS. Fractures of the coronoid process. Hand Clin 2004;20:443–53.
Reckling FW. Unstable fracture dislocations of the forearm (Monteggia and Galeazzi lesions). J Bone Joint Surg 1982;64A:857–63.
O’Discroll SW, Morrey BF, Korinek S, An KN. Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop 1992;280:186–97.
Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 1954;42:123–32.
Harrington IJ, Sekyi-Otu A, Barrington TW, Evans DC, Tuli V. The functional outcome with metallic radial head implants in the treatment of unstable elbow fractures: a long term review. J Trauma 2001;50:46–52.
Jensen Sl, Deutch SR, Olsen BS, Sojberg JO, Sneppen O. Laxity of the elbow after experimental excision of the radial head and division of the medial collateral ligament: efficacy of ligament repair and radial head prosthetic replacement: a cadaver study. J Bone Joint Surg 2003;85B:1006–110.
Schneeberger AG, Sadowski MM, Jacob HA. Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg 2004;86A:975–82.
Moro JK, Werier J, MacDermid JC, Patterson SD, King GJ. Arthroplasty with a metal radial head for unreconstructable fractures of the radial head. J Bone Joint Surg 2001;83A:1201–11.
Lill H, Verheyden P, Rose T, Hepp P, Josten C. Fracture dislocation of the elbow joint. Strategy for treatment and results. Arch Orthop Trauma Surg 2001;121:31–7.
Beaty JH, Kasser JR. Fractures about the elbow. Instr Course Lect 2001;44:215–19.
Morrey BF, An KN. Articular and ligamentous contributions of the stability of the elbow joint. Am J Sports Med 1983;11:315–19.
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analysis. J Bone Jont Surg 1976;58A:453–8.
Trousdale RT, Amadio PC, Cooney WP, Morrey BF. Radio-ulnar dissociation. Review of twenty cases. J Bone Joint Surg 1992;74A:1486–97.
Pugh DMW, McKee MD. The terrible tried of the elbow. Tech Hand Upper Extremity Surg 2002;6:21–9.
Babb A, Carlson WO. Monteggia fractures: beware! S D J Med 2005;58:283–5.
Eathiraju S, Mudgal CS, Jupiter JB. Monteggia fracture-dislocations. Hand Clin 2007;23:165–77.
Ring D, Jupiter JB, Waters PM. Monteggia fractures in children and adults. J Am Acad Orthop Surg 1998;6:215–24.
Boyd HB, Boals JC. The Monteggia leasion: a review of 159 cases. Clin Orthop 1969;66:94–100.
Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg 1986;68A:669–74.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Josten, C., Freitag, S. Monteggia and Monteggia-like-lesions: Classification, Indication, and Techniques in Operative Treatment. Eur J Trauma Emerg Surg 35, 296–304 (2009). https://doi.org/10.1007/s00068-008-8028-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-008-8028-6