A Comparison of Monteggia Fractures in Children and Adults

Jung Ryul Kim; Sung Il Wang; Hyung Suk Lee

doi:10.4055/jkoa.2009.44.4.461

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Kim, Wang, and Lee: A Comparison of Monteggia Fractures in Children and Adults

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(4): 461-466.

Published online: 21 July 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.4.461

A Comparison of Monteggia Fractures in Children and Adults

Jung Ryul Kim, M.D., Ph.D., Sung Il Wang, M.D., Hyung Suk Lee, M.D.

Department of Orthopaedic Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine, Jeonju, Korea.

Correspondence to Jung Ryul Kim, M.D., Ph.D. Department of Orthopaedic Surgery, Chonbuk National University Medical School, 634-18, Geumam-dong, Dugjin-gu, Jeonju 561-712, Korea. TEL: +82.63-250-1767, FAX: +82.63-271-6538, jrkeem@chonbuk.ac.kr

Received 28 August 2008 Accepted 27 May 2009

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.

Keywords: Children, Adult, Monteggia fracture

Figures and Tables

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.

Table 1

Criteria for Judging Results (Bruce et al.)

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