Arch Hand Microsurg.  2019 Mar;24(1):50-55. 10.12790/ahm.2019.24.1.50.

Stress Fracture of Olecranon after Plate Fixation for Osteoporotic Monteggia Fracture with Absence of Radial Head: A Case Report

• Jung HS
• Park JK
• Shon HC
• Kang SW
• Cha JK
• Go BS

• KMID: 2440611
• DOI: http://doi.org/10.12790/ahm.2019.24.1.50

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.

Keyword

Monteggia fracture; Stress fracture; Osteoporosis

MeSH Terms

Dislocations
Elbow
Fractures, Stress*
Head*
Humans
Joints
Monteggia's Fracture*
Neck
Olecranon Process*
Osteoporosis

Figure

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  Fig. 1 Ulnar corrective osteotomy and radial head excision were perfomed for the Bado type II chronic Monteggia fracture with the posterior aspect of the ulna.

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  Fig. 2 One year after the operation, complete union of the ulnar fracture and correct alignment of the elbow were confirmed.

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  Fig. 3 Six years after the surgery, a fracture of the olecranon was observed, starting from the proximal screw of the compression plate used for the ulnar fracture.

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  Fig. 4 For stress fractures of the olecranon, a long locking compression plate was added and fixed to the end of the olecranon.

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  Fig. 5 Open reduction and internal plate fixation were performed for a Bado type I chronic Monteggia fracture with nonunion of radial neck, and dislocation of radial head was reduced.

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  Fig. 6 After 8 weeks of operation, a fracture of the olecranon, starting from the proximal screw of the locking plate used for ulnar fracture, is observed.

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  Fig. 7 For the stress fracture of the olecranon, the previous plate was removed and the long locking plate was fixed to the end of olecranon.

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