J Korean Orthop Assoc.  2009 Aug;44(4):461-466.

A Comparison of Monteggia Fractures in Children and Adults

• Kim JR
• Wang SI
• Lee HS

Abstract

PURPOSE
This study compares the mechanism of injury and the treatment outcomes in children and adults with Monteggia fractures. MATERIALS AND METHODS: 30 patients with Monteggia fractures were treated. There were 14 children with an average age of 8.6 years and 16 adults with an average age of 36.2 years. The results are based on a review of the clinical records and the initial radiographs combined with a follow-up examination. RESULTS: Pediatric Monteggia fractures were almost always found to be the result of low energy trauma (86%), but in adults, these fractures were most often found to be result of high energy trauma (88%). There were high prevalence of type III fractures with concomitant posterior interosseous nerve injury in the children. There were 7 serious complications in the adults. CONCLUSION: The clinical outcomes of Monteggia fracture in children were satisfactory as compared to that in adults. Yet, we recommend cautiously diagnosing and treating this injury in children because most type III fractures were accompanied by posterior interosseous nerve injury.

Keyword

Children; Adult; Monteggia fracture

MeSH Terms

Adult
Child
Follow-Up Studies
Humans
Monteggia's Fracture
Prevalence

Figure

• 

  Fig. 1 (A) A 31-year-old man sustained Monteggia fracture caused by fall from a height. Preoperative radiographs shows Bado type II Monteggia lesion with combined proximal radius fracture involving radial head. (B) Open reduction and internal fixation was performed. (C) The last follow-up radiograph shows the stable reduction of radial head and bone union of both fractures.

• 

  Fig. 2 This graph shows the mechanism of injury. Lower energy injuries were prevalent in children, whereas high energy injuries were prevalent in adults. There was a significant difference in cause of injury between children and adults.

• 

  Fig. 3 This graph shows the types according to the Bado classification. Bado Type I & III Monteggia lesions were equally prevalent in children, but Bado type I was predominant in adults.

• 

  Fig. 4 (A) Preoperative radiographs of 9-year-old girl show Bado type III Monteggia lesion accompanied by posterior interosseous nerve injury. (B) Both lesions were failed with closed reduction. After open reduction and internal fixation of ulnar fracture site, open reduction of radial head was performed. (C) Ulnar fracture was treated with circumference wiring and unstable radial head dislocation was treated with transcapitellar k-wire fixation. (D) At final follow-up, nerve lesion was completely resolved, and she had full range of motion. But, Plain radiograph taken after hardware removal at one year after injury shows that radial head was subluxated laterally.

• 

  Fig. 5 This graph shows the functional results in 14 children and 16 adults with Monteggia lesions. All but one case showed satisfactory result in children, but 44% of adults were unsatisfactory result.

Reference

1. Bado , JL . The Monteggia lesion. Clin Orthop Relat Res. 1967. 50:71–86.

2. Eglseder WA, Zadnik M. Monteggia fractures and variants: review of distribution and nine irreducible radial head dislocations. South Med J. 2006. 99:723–727.

3. Konrad GG, Kundel K, Kreuz PC, Oberst M, Sudkamp NP. Monteggia fractures in adults: long-term results and prognostic factors. J Bone Joint Surg Br. 2007. 89:354–360.

4. Onley BW, Menelaus MB. Monteggia and equivaleni lesions in childhood. J Pediat Orthop. 1989. 9:219–223.

5. Ovesen O, Brok KE, Arreskøv J, Bellstrøm T. Monteggia lesions in children and adults: an analysis of etiology and long-term results of treatment. Orthopedics. 1990. 13:529–534.

6. Moon ES, Rowe SM, Ryang DH, Lee GH. A clinical study fo the monteggia lesion in children. J Korean Orthop Assoc. 1992. 27:1846–1853.

7. Song KS, Lee KW. Diagnosis and treatment of monteggia fracture in children. J Korean Orthop Assoc. 2000. 35:415–420.

8. Bruce HE, Harvey JP Jr, Wilson JC Jr. Monteggia fractures. J Bone Joint Surg Am. 1974. 56:1563–1576.

9. Bryan RS. Monteggia fracture of the forearm. J Trauma. 1971. 11:992–998.

10. Boyd HB, Boals JC. The monteggia lesion. A riview of 159 cases. Clin Orthop Relat Res. 1969. 66:94–100.

11. Morton S, Bernard D, Joel T. Posterior interosseous nerve palsy as a complication of Monteggia fractures in children. Clin Orthop Relat Res. 1968. 58:141–145.

12. Spar I. A neurologic complication following Monteggia fracture. Clin Orthop Relat Res. 1977. 122:207–209.

13. Smith FM. Monteggia fractures. An analysis of twenty-five consecutive fresh Injuries. Surg Gynec and Obstet. 1947. 85:630–640.

14. Spinner M. Posterior interosseous nerve palsy as a complication of Monteggia fracture in children. Clin Orthop Relat Res. 1968. 58:141–145.

15. Wiley JJ, Pegington J, Horwich JP. Traumatic dislocation of the radius at the elbow. J Bone Joint Surg Br. 1974. 56:510–517.

16. Evans EM. Pronation injuries of the forearm, with special reference to the anterior Monteggia fracture. J Bone Joint Surg Br. 1949. 31:578–588.