[Posterior monteggia fracture-dislocations of proximal ulna].
OBJECTIVE
To discuss the diagnosis and differential diagnosis, and to establish an effective protocol to treat the posterior Monteggia fracture-dislocations of proximal ulna in adult according to our experience.


METHODS
Between April 2004 and December 2007, 16 patients with posterior Monteggia fracture-dislocations were treated surgically, 13 were followed up at a mean of 28 months (range, 12 - 58 months). All the operations were through the posterior midline approach. The fractures of radial head and coronoid process were reduced and fixed, if possible. The proximal ulna fractures were fixed with a single plate in 7 cases, plate combined with K-wires in 2, plate combined with K-wires tension band in 3, and K-wires tension band combined with screws in 1.


RESULTS
No elbow was painful or unstable at the last follow up examination. They had an average of 100 degrees (range, 0 degrees to 145 degrees ) of flexion-extension of elbow. The average motion of forearm rotation was 119 degrees (range, 0 degrees to 170 degrees ). The mean Mayo Elbow Performance Score (MEPS) was 93.1 points (67 - 100 points), excellent and good results were achieved in 92.3%. The mean system of Broberg and Morrey score was 88.8 points (53 - 100 points), excellent and good results were achieved in 76.9%.


CONCLUSIONS
Attention should be paid to the diagnosis and differential diagnosis of the posterior Monteggia fracture-dislocation of proximal ulna. Anatomically reduction and stable fixation of proximal ulna is the keystone for the surgical treatment.
Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China.
Ting
T
Li
Xie-Yuan
XY
Jiang
Jian
J
Zhang
Qi-Yong
QY
Cao
Li-Dan
LD
Zhang
Xing-Hua
XH
Liu
Mao-Qi
MQ
Gong
Xing
X
Teng
Man-Yi
MY
Wang
D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D001864:Bone Wires; D003937:Diagnosis, Differential; D004551:Elbow Joint / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009011:Monteggia's Fracture / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome