Monteggia-like lesions: preliminary reports and mid-term results of a single center

COMPLICATIONS AFTER SURGICAL TREATMENT OF JUPITER'S MONTEGGIA TYPE II FRACTURES

Monteggia fracture-dislocations are rare injuries, affecting about 2-5% of the population. Jesse Jupiter subdivided Bado's Type II fractures into four types, all of which presented an associated radial head fracture. Associated chondral and ligament injuries can evolve with postoperative complications.

Objective

To evaluate the incidence of complications and risk factors that may influence the postoperative outcomes of Jupiter lesions.

Methods

This retrospective study was conducted with surgically treated patients. The characteristics related to fractures and surgical approaches were evaluated and these variables were correlated with radiographic and functional postoperative complications.

Results

A total of 15 patients were evaluated, mostly men and with a higher prevalence of Types IIA and IID. The most frequent complications were heterotopic ossification and osteolysis around the radial head prosthesis. Postoperative instability occurred only in the lateral collateral ligament. According to MEPS functional score, 53% of the patients evolved with unfavorable outcomes.

Conclusion

The studied cases evolved with high rates of postoperative complications, mainly in Jupiter's Type IID fractures and associated coronoid fractures. Level of Evidence III, Therapeutic Study.

Monteggia fractures and Monteggia-like-lesions: a systematic review

Monteggia injuries are rare, but severe injuries of the elbow including various injury patterns. Treatment of these injuries is still topic of debate and strategies differ widely. In this systematic review on Monteggia injuries in adults, we aimed to clarify the incidence of different injury patterns within Monteggia injuries, investigate the main reasons leading to revision surgery and explore which surgical treatments should be favored to achieve satisfactory clinical results.We initially identified 182 publications and ultimately included 17 retrospective studies comprising 651 cases. All patients were classified using the Bado classification, leading to 30.5% Bado type I fractures, 60.4% type II fractures, 5.1% type III and 3.1% type IV fractures. Mean revision rate was 23%. Ulna non-union (28%) and limited range-of-motion (22%) are the main reasons for revision surgery. Meta-analysis shows a trend toward the use of locking plates for ulna fixation which may lead to less revision surgery and fewer ulna non-unions. Further biomechanical and clinical research is necessary to clarify the role of radial head surgery.