Arch Hand Microsurg 2019; 24(1): 50-55  
Stress Fracture of Olecranon after Plate Fixation for Osteoporotic Monteggia Fracture with Absence of Radial Head: A Case Report
Ho-Seung Jung, Ji-Kang Park, Hyun-Chul Shon, Sang-Woo Kang, Jung-Kwon Cha, Ban-Suk Go
Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Korea
Correspondence to: Ji-Kang Park
Department of Orthopaedic Surgery, Chungbuk National University Hospital, 776 1sunhawn-ro, Seowon-gu, Cheongju 28644, Korea
TEL: +82-43-269-6077, FAX: +82-43-274-8719, E-mail: carm0916@hanmail.net
Received: October 26, 2018; Revised: November 21, 2018; Accepted: December 17, 2018; 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
When treating a Monteggia fracture, it would be ideal to achieve reduction of dislocation while preserving the radial head. But if preservation of radial head is impossible, radial head replacement may be performed after removing the head. However, in patients who require head resection because it was impossible to replace the radial head, the load applied on the elbow is concentrated on the ulnohumeral joint. If a metal plate is used in this area to fix an ulnar shaft fracture, the proximal screw may act as a stress riser to make the area vulnerable to a fracture. We experienced cases of stress fracture in the olecranon of along the screw insertion due to the proximal screw acting as a stress riser, used in open reduction and metal plate fixation for ulnar shaft fractures in osteoporotic patients with Monteggia fracture who had the radial head removed or had nonunion after previous radial neck fracture.
Keywords: Monteggia fracture, Stress fracture, Osteoporosis


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