Posterior monteggia fracture- dislocations

Abstract

The Posterior Monteggia fracture-dislocation is an injury pattern involving a diaphyseal or proximal ulnar fracture associated with posterior subluxation or dislocation of the radiocapitellar joint. Additional injury to the radial head and lateral ulnar collateral ligament complex is common. Recognizing the extent and pattern of injury is important so that all components to elbow stability can be addressed. Management is centered upon reconstruction of length and alignment of the ulna, including the appropriate restoration of alignment of the coronoid and olecranon processes to one another if the trochlear notch is involved. Posterior contoured plating of the ulna has shown the most predictable results of maintaining fracture alignment. The need for lateral ulnar collateral ligament repair and management of the radial head should be evaluated on an individual basis, understanding that both are significant contributors to elbow stability. Complications such as arthrosis, heterotopic ossification, and synostosis are common. Although these are difficult and complex injuries to manage, a thorough recognition of the pattern of injury, as well as systematic approach to reconstruction, can maximize patient outcomes.