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Long-term evaluation of surgically treated anterior monteggia fractures in skeletally mature patients

Thierry G Guitton, David Ring, Peter Kloen
Journal of Hand Surgery 2009, 34 (9): 1618-24

PURPOSE: The purpose of this retrospective study was to evaluate the functional and radiological long-term outcome of open reduction and internal fixation of skeletally mature patients with a Bado type 1 Monteggia fracture.

METHODS: We identified 11 consecutive skeletally mature patients who had surgical treatment of an anterior (Bado type 1) Monteggia fracture. Long-term evaluation at a median of 20 years after injury (range, 7-34 years) was compared with an early evaluation at a median of 13 months after injury (range, 11-32 months). The early and long-term results were evaluated radiographically and according to the system of Broberg and Morrey. The long-term result was also evaluated according to the Mayo Elbow Performance Index, the American Shoulder and Elbow Surgeons, and the Disabilities of the Arm Should and Hand scores.

RESULTS: Two patients had subsequent surgery to address a nonunion and 3 elbows had radiographic signs of arthrosis. The mean arc of elbow flexion increased from 110 degrees (range, 35 degrees to 140 degrees) at early follow-up to 120 degrees (range, 40 degrees to 150 degrees) at late follow-up. The mean arc of forearm rotation increased from 145 degrees (range, 90 degrees to 180 degrees) to 149 degrees (range, 90 degrees to 180 degrees). The mean Broberg and Morrey score increased from 89 points (range, 62-100 points) to 94 points (range, 76-100 points). The median DASH score was 7 points (range, 0-34 points) at long-term follow-up. There was no statistical difference between early and late range of motion or Broberg and Morrey score.

CONCLUSIONS: The results of open reduction and internal fixation of anterior Monteggia fractures in skeletally mature patients are maintained over long-term follow-up.


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