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Monteggia fractures in children and adults

Harvard Combined Orthopaedic Residency, Massachusetts General Hospital, Boston, MA, USA.

The eponymous term "Monteggia fracture" is most precisely used to refer to dislocation of the proximal radioulnar joint in association with a forearm fracture. It is the character of the ulnar fracture, rather than the direction of radial head dislocation, that is useful in determining the optimal treatment of Monteggia fractures in both children and adults. Stable anatomic reduction of the ulnar fracture results in anatomic reduction of the radial head. The notoriously poor results of treatment of Monteggia fractures in adults improved dramatically after the development of modern techniques of plate-and-screw fixation, which facilitate early mobilization by ensuring anatomic reduction. The relatively good results associated with nonoperative treatment of pediatric Monteggia injuries reflect the prevalence of stable (incomplete) fractures in children. Unstable (complete) ulnar fractures are prone to residual or recurrent displacement and may require operative fixation. Late reconstruction of chronic Monteggia lesions in children can be complicated and unpredictable. The key to a good outcome after a Monteggia-type fracture-dislocation of the forearm remains early recognition of proximal radioulnar dissociation.