Comminuted Monteggia Fracture

Comminuted Monteggia Fracture

Monteggia fracture is a fracture of the proximal ulna and radial head subluxation. It is imperative that you restore the length and the proper alignment of the ulna so that the radial head can be reduced. If we malalign the ulna, then the radial head will remain subluxed. There are some cases where the fracture of the ulna is so comminuted that we will be unable to restore the length of the ulna. We will not even know if we restored the length of the ulna.

There is a technique that I use in the reconstruction of the ulna in cases where the ulna is too comminuted. I will open the fracture ulna, and I will approach the radial head. I will reduce the radial head to the capitellum and reduce the ulna to the radius and make sure that the proximal radioulnar joint is anatomic. Once that joint is anatomic, I will pin it with either one or two K wires. I transfix the ulna to the radial head. We know that the radial head is reduced, now the ulna will be reduced because the radioulnar joint is reduced. We are temporarily transfixing the ulna to the radial head, and that will help to restore the proper length of the ulna. Once the proper length of the ulna is defined, then reconstruction of the ulna is simplified utilizing a dorsal ulnar plate. Next, the K wires are removed and the radioulnar joint is tested for stability. Occasionally, the K wires may be left in place for a few weeks if needed to provide additional stability, then removed later on.