Monteggia fractures in adults.

From January 1978 to December 1989, 60 adult acute Monteggia fractures were treated and followed-up for at least one year (average 3 years 9 months). Ulnar fractures were treated with open reduction and internal fixation with a dynamic compression plate or a Rush pin, and 2 with minimal ulnar displacement were treated with closed reduction. Forty radial heads had a closed reduction, 6 required an open reduction with annular ligament repair or fascial reconstruction, and 14 were resected due to comminution. The results showed a 90% union rate with a 3.5 +/- 1.2 months union period. Functional evaluation revealed a 78% satisfactory rate. The unsatisfactory results were associated with severe soft tissue injury which restricted elbow range of motion, persistent posttraumatic neurological deficit of brachial plexus injury and subluxation or redislocation of the radial head. From theoretical and clinical considerations, the authors concluded that open reduction with rigid internal fixation of ulnar fracture and stable reduction of radial head should be the treatment of choice for Monteggia fractures.