title: Unusual patterns of Monteggia fracture-dislocation.
abstract: BACKGROUND
  High-energy trauma may result in uncommon open injuries around the elbow joint. The management of these injuries can be difficult.
  
  
  METHODS
  Fourteen patients were treated between 1999 and 2003 and their injuries consisted of Monteggia fracture-dislocations combined with segmental fractures of the ulna or fractures of the forearm bones and/or various more complex trauma such as neural injuries, bone comminution and severe soft tissue injuries around the elbow. Eight of them (57%) were multiply injured with severe additional injuries. All patients underwent surgery within first 4-6 hours. Internal fixation, external fixation or a combination of both methods were used to stabilize fractures while open wounds had secondary closure.
  
  
  RESULTS
  Additional operations were required in 6 patients. The functional results according to the Mayo Elbow Performance Index were excellent or good in eleven patients, and fair or poor in the remaining three. The patients with fair and poor results had suffered from severe neural and soft tissue trauma and/or multiple fractures of the upper extremity.
  
  
  CONCLUSIONS
  These injuries should be treated as an emergency. The surgeon should apply any available method that can provide stability to the bone fragments and safe handling of the soft tissues giving priority to internal fixation of the fractures. Severe osseous, soft tissue and neural trauma affect the functional results of the elbow region.
authors.affiliation: Department of Orthopaedics, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece. kazakosk@yahoo.gr
authors.forename: Constantinos J
authors.initials: CJ
authors.lastname: Kazakos
authors.forename: Vasilios G
authors.initials: VG
authors.lastname: Galanis
authors.forename: Dennis-Alexander J
authors.initials: DA
authors.lastname: Verettas
authors.forename: Alexandra
authors.initials: A
authors.lastname: Dimitrakopoulou
authors.forename: Alexandros
authors.initials: A
authors.lastname: Polychronidis
authors.forename: Constantinos
authors.initials: C
authors.lastname: Simopoulos