Arch Hand Microsurg 2019; 24(1): 17-23  
Clinical Outcome of Acute Monteggia Fractures after Open Reduction and Internal Fixation of Ulna Alone
In Tae Hong, Go-Tak Kim, Eugene Baek, Soo-Hong Han
Department of Orthopedic Surgery, CHA Bundang Medical Center, Seongnam, Korea
Correspondence to: Soo-Hong Han
Department of Orthopedic Surgery, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea
TEL: +82-31-780-5270, FAX: +82-31-708-3578, E-mail: hsoohong@cha.ac.kr
Received: November 30, 2018; Revised: January 8, 2019; Accepted: January 9, 2019; Published online: March 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: Most of the patients who have acute Monteggia fracture require surgical treatment. Open reduction and restoration of the alignment for the ulna, and early reduction of the radial head are the principles of treatment. The authors performed anatomic reduction and plate fixation of the ulna in acute Monteggia fractures and the aim of this study is to report the radiological and clinical results of the management.
Methods: Medical records and imaging data of 13 patients who had only internal fixation of the ulna in acute Monteggia fracture were reviewed retrospectively. The mean age was 38.8 years and average follow-up period was 23.9 months. We evaluated the range of motion, Mayo elbow performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score and complications at the last follow-up. Bone union and reduction of the radial head were reviewed by assessing serial radiographs during the follow-up.
Results: Bone union was obtained in all cases and radial heads were maintained their reduced position on the follow-up radiographs. The mean MEPS was 91.15 and the mean DASH score was 7.9 at the last follow-up. The mean elbow flexion was 136.5°, elbow extension was 1.2°, forearm pronation was 79°, and forearm supination was 71°. There was no specific complication during the follow-up and 3 patients had secondary surgery for plate removal by patients’’ request.
Conclusion: Anatomical reduction and secure fixation of the ulnar fracture without manipulating radial head dislocation in the acute Monteggia fracture showed satisfactory outcome in this study.
Keywords: Monteggia fracture, Fracture dislocation, Fracture fixation, Open fracture reduction


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