Surgical treatment of Monteggia variant fracture dislocations of the elbow in adults: surgical technique and clinical outcomes

Hosam E. Matar, Pavel I. Akimau, David Stanley, Amjid A. Ali

Monteggia variant defined as Monteggia fracture dislocation with radial head or neck fracture, coronoid fracture, ulnohumeral joint dislocation or combination of these injuries. The aim of this study was to evaluate clinical outcomes of surgical treatment of Monteggia variant fracture dislocations with focus on the operative technique and management of associated radial head fractures. Between January 2008 and January 2014, 22 patients (7 men, 15 women) with a mean age of 58.9 years (45-77 years) and unilateral Monteggia variant were included. The mean follow-up was 4.1 years (2.2-6.6 years). Patients underwent clinical and functional assessment using the Mayo Elbow Performance Index and the Oxford Elbow Score. Eighteen patients had radial head fractures; in five patients the fracture fragment involved less than one-third of the radial head and the fragment was excised, in four patients the radial head fracture was fixed with headless screws and in nine patients the radial head was replaced. At review the mean Mayo Elbow Performance Index was 76.6 (20-100) and the Oxford Elbow Score 35 (4-48). Our experience suggests that satisfactory outcomes can be obtained in the treatment of the complex Monteggia variant fracture dislocations by recognising the injury pattern and addressing all components of the injury in order to achieve elbow stability.