A fragment-specific approach to Type IID Monteggia elbow fracture-dislocations.

OBJECTIVES: To describe the pattern of injury, surgical technique, and outcomes of Monteggia Type IID fracture dislocations.

DESIGN: Retrospective review of prospectively collected clinical and radiographic patient data in an orthopaedic trauma database.

SETTING: Level I university-based trauma center.

PATIENTS/PARTICIPANTS: All patients with Monteggia Type IID fracture-dislocations admitted from January 2000 to July 2005.

INTERVENTION: Review of patient demographics, fracture pattern, method of fixation, complications, additional surgical procedures, and clinical and radiographic outcome measures.

MAIN OUTCOME MEASUREMENTS: Clinical outcomes: elbow range of motion, complications. Radiographic outcomes: characteristic fracture fragments, quality of fracture reduction, healing time, degenerative changes, and heterotopic ossification.

RESULTS: Sixteen patients were included in the study. All fractures united. There were six complications in six patients, including three contractures with associated heterotopic ossification, one pronator syndrome and late radial nerve palsy, one radial head collapse, and one with prominent hardware.

CONCLUSIONS: Monteggia IID fracture-dislocations are complex injuries with typical specific fracture fragments. Anatomic fixation of all injury components and avoidance of complications where possible can lead to a good outcome in these challenging injuries.