Depending on the injured ligamentary structures an increasing dislocation (primarily in posterior and lateral direction) was observed after successive resection up to the interosseous membrane. In a preliminary biomechanical study of the authors, the stability in the proximal radio-ulnar joint (PRUJ) was directly related to the affected ligamentary structures between ulna and radius. A hypothesis postulates that the ligament structures tear up to or even beyond the level of the ulna fracture which can be comparable to injuries of the syndesmosis at the ankle joint. In case of radial head dislocation, the joint capsule and further ligamentary structures between ulna and radius are likely to be injured. The site of ulnar fracture is not being considered in present classifications. Grading of Monteggia injuries follows the Bado classification, which focuses on the direction of the radial head dislocation, whereby the ulna fracture can occur at very distinct locations. of the radial head or the coronoid process) are present, injuries are being considered as Monteggia-like lesions (MLL). Trial registration Registration was done with under NCT05325268.Ī Monteggia fracture (MF) is defined as a fracture of the proximal ulna combined with a dislocation of the radial head. Intraarticular fractures or injuries with a close relation to the joint have a worse prognosis, especially if the coronoid process is injured. However, we could not confirm the hypothesis of an increasing instability in ulnar fractures located further distally (high severity of the potential ligamentous injury). The presented results suggest that in Monteggia fractures and Monteggia-like lesions, the localization of the ulna fracture can give a hint for its postoperative outcome. Patients with an accompanying injury of the coronoid process displayed higher pain levels ( p = 0.011), a worse functionality ( p = 0.027) and overall lower scoring in PROM. Comparing patients with and without fracture of the radial head, we observed no differences.
Subgroup A displayed a worse extension capability ( p = 0.027) and patients were significantly older ( p < 0.01). We found no differences between the subgroups regarding the PROMs. Average pain according to visual analogue scale was 1.6 (± 1.9). Average extension capability reached − 7° (± 7.5). Cases were divided into subgroups depending upon the distance of the ulnar fracture site in respect to its distal endpoint (A: 7 cm). Bado II-fractures were further classified according to Jupiter (A:7, B:16, C:3, D:1). Fractures were classified according to Bado (I:2, II:27, III:4, IV:2). Follow-up took place after 50.5 months (± 22.1). Furthermore, treatment strategy and complications were analysed. In a follow-up examination validated patient-reported outcome measures and functional parameters were evaluated. Fractures were classified according to Bado and Jupiter, the site of the fracture location at the proximal ulna and regarding the potential accompanying ligamentary injury. In a retrospective, monocentric study 35 patients who underwent surgical treatment after suffering a Monteggia injury or Monteggia-like lesion were included. Key objective was to evaluate whether the site of the ulnar fracture can be correlated to clinical outcome after open reduction and internal stabilization. Preliminary biomechanical studies suggested a correlation between ulnar fracture localization and clinical result.
Monteggia fractures and Monteggia-like lesions result after severe trauma and have high complication rates.
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