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Technique Spotlight: ORIF Monteggia Fractures
Introduction
A Monteggia fracture-dislocation, defined as a proximal ulna fracture with a concurrent proximal radioulnar joint dislocation, is a rare but complex injury of the forearm and elbow. Monteggia fracture-dislocations account for 1%–2% of forearm fractures and are commonly secondary to a direct force to the forearm while the elbow is extended and the forearm is pronated. Several classification systems have been proposed to describe these injuries based on both the direction of radial head dislocation and the osseous structures involved. Stability of the elbow is conferred by the ulnar collateral ligament, the coronoid, the radial head, the radial collateral ligament, and the annular ligament. Concurrent injury to these structures can destabilize the elbow and should be carefully evaluated prior to surgical management, as the goal of treatment is to restore elbow stability and facilitate early range of motion.
Indications
The vast majority of Monteggia fractures in adults require operative management to ensure reduction of the ulna and radial head. Loss of alignment and reduction is common in adults treated with closed management and the morbidity of persistent elbow dislocation is high. Furthermore, operative fixation allows for early range of motion, preventing the development of arthrofibrosis and loss of elbow motion.
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