Monteggia-like lesions A case series

• Published in: Obere extremität Vol. 14; no. 1; pp. 53 - 59
• Main Authors: Schmalzl, J., Sadler, N., Feucht, M., Gerhardt, C., Lehmann, L. J.
• Format: Journal Article
• Language: English
• Published: Munich Springer Medizin 01-03-2019
• Subjects: Medicine; Medicine & Public Health; Original Contribution; Orthopedics; Surgical Orthopedics; Radial head fracture; Radiuskopffraktur; Operative Therapie; Ellenbogen Luxation; Surgical treatment; Processus Coronoideusfraktur; Elbow luxation; Monteggia-like lesion; Coronoid fracture; Monteggia-ähnliche Fraktur
• ISSN: 1862-6599; 1862-6602
• DOI: 10.1007/s11678-018-0485-x

Introduction
Monteggia-like fractures are rare but complex injuries to the elbow joint, accounting for 2–5% of proximal forearm fractures. Even for experienced surgeons, their treatment can be challenging. The objective of this retrospective study was to analyze the short-term results after surgical treatment of Monteggia-like fractures in adults.
Methods
All patients who sustained a Monteggia-like fracture over a period of 3 years (2014–2016) and underwent surgical treatment in the authors’ institution were followed-up. Pain level (visual analogue scale, VAS), range of motion (ROM), Broberg and Morrey Score (BMS), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) Score, and subjective elbow score (SEV) were recorded.
Results
Of 14 adult patients who sustained a Monteggia-like lesion during a 3-year period, 13 were available for follow-up after a mean time of 21.9 months (7 to 44 months). According to the BMS, 3 patients (15%) showed excellent, 7 (54%) good, 2 (15%) fair, and 2 (15%) poor results. A total of 3 patients (23%) needed revision surgery other than implant removal. Mean BMS was 79 (23 to 100), mean MEPS was 82 (35 to 100), mean DASH score was 23.6 (0 to 61), mean SEV was 66% (20 to 90), and mean VAS was 2.6 (0–8).
Conclusion
Good short-term results can be achieved if the injury is classified correctly and a standardized surgical treatment of all injury components is performed. The results are comparable with data from the literature. Patients with Monteggia-like fractures should be informed about the risk of potential functional deficits and the possible need of further surgery.
Level of evidence
This study is evidence level IV.