In a Monteggia fracture-dislocation, the ulnar fracture is associated with a dislocation of the radial head at the radiocapitellar joint; the proximal radioulnar joint is also disrupted. In most cases, the radial head dislocates anteriorly or laterally; rarely posteriorly.
In Monteggia fracture-dislocations, anatomical reduction and stable fixation of the ulna are mandatory, if a satisfactory outcome is to be achieved. The ulnar fracture must be anatomically reduced in order to ensure accurate relocation of the radial head.
Once operative fixation is completed, the surgeon must ensure the stability of the reduced radial head, preferably under image intensification. In many cases the radial head is only stably reduced with the forearm in supination and the elbow at a right angle.
Intramedullary nailing of forearm fractures is currently limited to pediatric fractures and severe multifragmentary injuries of one or both forearm bones in the presence of devastating soft-tissue damage. Pediatric fractures are not included in this module of AO Surgery Reference. Discussion of nailing in adult forearm shaft fractures is confined to multifragmentary fractures of both bones in adult AO Surgery Reference.
|Surgical treatment not possible|
This is only indicated when surgical fracture treatment is impossible. A good functional result is unlikely.
|A means of temporary fixation for severely open fractures|
External fixation can be indicated in severely open fractures as means of temporary fixation (with a view to later conversion to internal fixation).
|ORIF - Plating|
|Treatment of choice|
In Monteggia fracture-dislocations, anatomical reduction and stable fixation of the ulna and stable reduction of the radial head are only likely to be achieved by plating. These fractures therefore present strong indications for plating.
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|