title: Does a Monteggia variant lesion result in a poor functional outcome?: A retrospective study.
abstract: We retrospectively reviewed the clinical and functional outcomes after operative fixation of ipsilateral fractures of the proximal ulna, radial head or neck, and radial head dislocation (Monteggia variant). Twenty of 25 patients who sustained this injury returned for followup at a mean of 2.3 years and were evaluated by an independent examiner. Radiographically, 17 of 20 fractures united after the index surgery. The three patients who had nonunions develop had Bado Type 2 fracture patterns. The fractures of two patients united after revision internal fixation, and bone grafting. Seven patients had heterotopic ossification develop and 14 of 20 patients had arthritic changes develop. The mean Broberg and Morrey score was 79.1 (range, 32.5-100) and the mean disability of the arm, shoulder and hand score was 64.1 (worse outcome than the general population). Eight of 20 patients required revision surgery (three for recurrent instability, three for nonunion of the ulna, one for radial head excision and hardware removal, and one for hardware removal alone). Nine of 20 patients had fair or poor outcomes according to the Broberg and Morrey scale. Physicians should counsel patients that functional impairment is common after these complex high-energy injuries.
  
  
  METHODS
  Prognostic study, Level IV (case series). See the Guideline for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, New York University Hospital for Joint Diseases, New York, NY 10016, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Egol
authors.forename: Nirmal C
authors.initials: NC
authors.lastname: Tejwani
authors.forename: Jamal
authors.initials: J
authors.lastname: Bazzi
authors.forename: Anand
authors.initials: A
authors.lastname: Susarla
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Koval
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D019317:Evidence-Based Medicine; D005260:Female; D017102:Fracture Healing; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D009011:Monteggia's Fracture / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome