In 1814, Giovanni Battista Monteggia first described two cased of fracture of proximal third of ulna with a dislocation of radial head, and this combined injury is now known as the Monteggia fracture. Despite its rarity, the importance of early recognition of dislocated radial head and correct treatment has been emphasized. Eight cases of Monteggia fracture were studied from March, 1984 to June, 1987. The results are as follows 1. Male patients were six and female were two. 2. The frequent cause of injury was fall down in four cases. 3. Bado type I accounted for 50%, type II for 12.5% and type III for 37.5%. 4. The level of ulna fracture was above upper one third of ulna in seven. 5. The common direction of dislocated radial head was anterior. 6. Two children and two adults were managed by closed reduction. 7. The results (by Bruce et al. criteria) were 3 excellent, 2 good, 1 fair and 2 poor. Four ulna fractures in adult were treated by open reduction and internal fixation using a semitubular plate.
Adult ; Child ; Clinical Study* ; Dislocations ; Female ; Head ; Humans ; Male ; Monteggia's Fracture* ; Ulna ; Ulna Fractures

OBJECTIVEMonteggia fracture dislocation equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a review of the literature.

METHODSA retrospective record of Monteggia fracture dislocation (2003-2008) was reviewed from medical record department of our institute. Classic Monteggia fracture dislocation, children below 12 years or adults over 50 years, as well as open grade II and III cases were excluded from this study. Monteggia variant inclusion criteria included fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 females with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients.

RESULTSFollow-up ranged from 1-4 years, mean 2.6 years. Patients were assessed clinicoradiologically. Mayo Elbow Performance Score was employed to assess the outcomes. At final follow-up, the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20 degree 116 degree, 50 degree and 55 degree for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures.

CONCLUSIONSMonteggia fracture dislocation equivalents are rare injuries and pre-surgery recognition by radiographs and 3-D CT helps make optimal plan. The poor results usually relate to intraarticular damage, coronoid fractures and comminution of the ulna and radial head fractures.

In 1814, Monteggia first described a fracture of proximal third of the ulna with a dislocstion of radial head. Bado named Monteggia lesion as a fraeture of ulnar at any level and a dislocaion of radial head and classified fracture as 4 types. The authors reviewed thirty-two patients of Monteggia fracture who were trested at department of orthopedic surgery, Kyung Pook University college of medicine from 1977. 1 to 1986. 12. Using new criteria of Bruce et al we evaluated results for 20 paients who follow up was possible. The results obtained were as follows ; 1. Tota 32 patients were 10 children and 22 aults. Male is 4 times more than female. 2. The cause of injury was fall down 12, trsffic accident 17 and machinsry injury 3 pati ents. 3. According to Bado clsssification, type I was 56%, type II 16%, type III 22% and type V 6%. 4. Direction of radial head dislocation was as follows ; Anterior was 16, anterolateral 10, posterior 3 posterolateral 1 latersl 2. 5. Location of ulna fracture site was as follows ; Metaphysis was 6, proximal 1/3 20, mid shaft 5, distal 1/3 1. 6. Treatments of dislocated radial head were closed reduction in 31 patients open reduction in 1 patient. 7. Treatment of fractured ulna was different between children and adult. 9 patients among ten children patient were managed by closed reduction, only 1 case by open reduction but all 22 adults were managed by open reduction and internal fixation. 8. Palsy of posterior interosseous nerve was observed in 6 and recovered completely within 8 months. 9. The results(Bruce et al) for 20 cases followed 5 months more were excellent 4 good 7 fair 5 poor 4. In children, prognosis and recovery was good and shorter.
Adult ; Child ; Clinical Study ; Dislocations ; Female ; Follow-Up Studies ; Head ; Humans ; Male ; Monteggia's Fracture ; Orthopedics ; Paralysis ; Prognosis ; Ulna ; Ulna Fractures

Elbow dislocation with concomitant diaphyseal fractures of radius and ulna has been reported rarely. This injury could be included in Monteggia equivalent lesions based on the mechanism of injury, radiographic pattern and method of treatment as described by Bado. We report a rare case of Monteggia equivalent lesion in an adult with unclear mechanism of injury. The possible mechanism of injury, its management and the follow-up results were described. An attempt to solve the controversy regarding whether labeling it as type 1 or type 2 was made.
Adult ; Elbow ; Humans ; Joint Dislocations ; Monteggia's Fracture ; Radius ; injuries ; Radius Fractures ; therapy ; Ulna

One of the points made against nailing in radius and ulna shaft fractures has been the loss of radial bow and its impact on function. The aims of the study were to assess the change in magnitude and location of the radial bow in radius and ulna shaft fractures treated with intramedullary square nails and to assess the impact of this change on functional outcome, patient reported disability and the range of motion of the forearm. We measured the magnitude of radial bow and its location in the operated extremity and compared it to the uninjured side in 32 adult patients treated with intramedullary square nailing for radius and ulna shaft fractures at our institute. The mean loss of magnitude of maximum radial bow was 2.18 mm which was statistically significant by both student-T test and Mann-Whitney U test with p value less than 0.01. The location of maximum radial bow shifted distally but was statistically insignificant. The magnitude of maximum radial bow had a negative correlation with DASH score that was statistically insignificant (R=- 0.22, p=0.21). It had a positive, statistically significant correlation to the extent of supination in the operated extremity (R = 0.66, p = 0.0004). A loss of up to 2mm of radial bow did not influence the functional outcome as assessed by criteria reported by Anderson et al. The magnitude of radial bow influenced the supination of the forearm but not the final disability as measured by DASH score. Intramedullary nailing did decrease the magnitude of radial bow but a reduction of up to 2mm did not influence the functional outcome.
Ulna Fractures ; Radius Fractures

Atypical fractures have been reported as a complication of long-standing bisphosphonate therapy and occur commonly in the subtrochanteric region or shaft of the femur showing typical radiographic features. We encountered a case of atypical fracture of the proximal one-third of the shaft of the ulna. Radiographic findings of this case differed from previously reported cases of ulnar fracture in terms of showing a transverse fracture line with cortical thickening and an oblique fracture line with anterior cortical spike. On the other hand, these findings were similar to radiographic features of atypical femoral fractures. The present case was managed surgically and union of fracture was achieved after 6 months. As there are possibilities of occurrence of atypical fractures in sites other than the femur, the physicians should cautiously examine the patients' history and radiographic findings.
Femoral Fractures ; Femur ; Forearm ; Hand ; Ulna*

Atypical fractures associated with prolonged bisphosphonate (BP) therapy rarely occur outside the femur, and the diagnostic criteria, appropriate treatment principles, and fixation methods for atypical ulnar fractures have not been established. The authors experienced the use of internal fixation with a metal plate and a new internal fixation method with an intramedullary nail in the treatment of an atypical ulnar fracture in a patient who had been on BP therapy for 10 to 20 years. This paper reports findings along with a review of the relevant literature.
Femur ; Fractures, Stress ; Humans ; Methods ; Osteoporosis ; Ulna

From January 1979 to December 1983, eighty-five patients who had forearm bone fracture were treated by four different methods at the Department of Orthopedic Surgery, Chosun University Hospital. The results were as follows: 1. Among 85 patients, 12 patients were radius fractures, 19 patients were ulna fractures, 54 patients were both forearm bone fractures. 2. Closed fractures were 70 patients and the open fractures were 15 patients. 3. The mst common fracture site was middle third of the both radius and ulna. 4. The treatments were closed reduction with cast immobilization, intramedullary nailing or plate and screw fixation. 5. The time required for radiological bone union were shorter in compression plate fixation gmup, than those treated with other fixation device. 6. Functional result was claasified according to the rating system of Smith and Sage. The open reduction and internal fixation group had better results than the conservatively treated group.
Forearm ; Fracture Fixation, Intramedullary ; Fractures, Bone ; Fractures, Closed ; Fractures, Open ; Humans ; Immobilization ; Orthopedics ; Radius ; Radius Fractures ; Ulna ; Ulna Fractures

Adult ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Ulna ; surgery ; Ulna Fractures ; therapy ; Young Adult

We have experienced multiple fractures of forearm both bones, which revealed the following fractures: comminuted fracture of olecranon, short oblique fracture of proximal ulnar shaft, transverse fracture of ulna mid-shaft, comminuted fracture of radial head, comminuted fracture of distal radius.
Forearm* ; Fractures, Comminuted ; Head ; Olecranon Process ; Radius ; Ulna