Monteggia-like lesions: preliminary reports and mid-term results of a single center

Main Article Content

Filippo Calderazzi
Margherita Menozzi
Alessandro Nosenzo
Cristina Galavotti
Sofia Solinas
Enrico Vaienti
Francesco Ceccarelli


Monteggia-like; complex elbow fractures; outcomes; surgical treatment


Background and aim of the work

Monteggia-like lesions are complex and rare elbow injuries. A detailed classification and a proper surgical treatment can provide quite good functional and radiological outcomes. The aim of this retrospective study was to evaluate the mid-term results of Monteggia-like lesions surgical treatment. The other purpose was to investigate whether the complexity of ulna and radius fractures could be prognostic factors of insufficient functional results.


Seven women and five men, with a mean age of 59,25 years who had sustained a Monteggia-like lesion were followed up clinically and radiologically after surgical treatment. The Mayo Elbow Performance Score (MEPS) and the Quick Disabilities of the Arm, Shoulder and Hand (QUICK-DASH) score were used for evaluation at a mean of 17,5 months postoperatively (12-26). The range of movement (ROM), patients’ satisfaction and neurological symptoms were also investigated. Osteolysis, implant loosening and heterotopic ossification were graded. Pearson’s test was used to correlate the different classification systems used (AO/OTA, Bado and Jupiter, PURCCS, Mason) with MEPS and QUICK-DASH score.


The mean MEPS was 84,92 (65 to 100). The mean QUICK-DASH score was 18,75 (0 to 34,1). The mean active pronation and supination was 72,5° and 59,17°, respectively. The mean active ROM of the elbow was 101,43°. Heterotopic ossifications were absent in six cases but were found in six. No statistically significant correlation was found between the analyzed variables.


Quite good functional results can be obtained in Monteggia-like lesions if injury pattern is recognized and each component of the injury is addressed. Further studies are needed to determine any prognostic factors.


Download data is not yet available.


Metrics Loading ...
Abstract 5 | PDF Downloads 0


1. Giannicola G, Sacchetti FM, Greco A, Cinotti G, Postacchini F. Management of complex elbow instability
Musculoskelet Surg 2010; 94 (Suppl 1): S25–S36 doi 10.1007/s12306-010-0065-8
2. Fayaz HC, Jupiter JB. Monteggia fractures in adults. Acta Chir Orthop Traumatol Cech 2010;77:457–462.
3. Matar HE, Akimau PI, Stanley D, Ali AA. Surgical treatment of Monteggia variant fracture dislocations of the
elbow in adults: surgical technique and clinical outcomes. Eur J Orthop Surg Traumatol 2017;Jul 27(5):599-
605. doi:10.1007/s00590-017-1953-5.
4. Reckling FW. Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). J Bone
Joint Surg Am 1982 Jul;64(6):857-63.
5. Giannicola G, Scacchi M, Sacchetti FM, Cinotti G. Clinical usefulness of proximal ulnar and radial
fracture-dislocation comprehensive classification system (PURCCS): prospective study of 39 cases.
Shoulder Elbow Surg 2013; 22, 1729-1736.
6. Bado JL. The Monteggia lesion. Clin Orthop Relat Res 1967;50:71–86.
7. Konrad GG, Kundel K, Kreuz PC, Oberst M, Sudkamp NP. Monteggia fractures in adults: long-term
results and prognostic factors. J Bone Joint Surg Br 2007 Mar; 89(3):354-60.
8. Giannicola G, Greco A, Sacchetti FM, Cinotti G, Nofroni I, Postacchini F. Complex fracture-dislocations
of the proximal ulna and radius in adults: a comprehensive classification. J Shoulder Elbow Surg
9. Laun R, Wild M, Brosius L, Hakimi M. Monteggia-like lesions – treatment strategies and one-year
results. GMS Interdiscip Plast Reconstr Surg DGPW 2015;4:Doc13.

10. Josten C, Freitag S. Monteggia and Monteggia-like-lesions Classification, Indication and Techniques. Eur J
Trauma Emerg Surg 2009 Jun;35(3):296-304. doi: 10.1007/s00068-008-8028-6.
11. Jungbluth P, Tanner S, Schneppendahl J, Grassmann JP, Wild M, Hakimi M, Windolf J, Laun R. The
challenge of Monteggia-like lesions of the elbow: mid-term results of 46 cases. Bone Joint J 2018
Feb;100-B(2):212-218. doi:10.1302/0301-620X.100B2.BJJ-2017-0398.R2.
13. Jupiter JB, Leibovic SJ, Ribbans W, Wilk RM. The posterior Monteggia lesion. Journal Orthop Trauma
14. Broberg MA, Morrey BF. Results of treatment of fracture-dislocations of the elbow. Clin Orthop Relat
Res 1987 Mar;(216):109-19.
15. Agarwal S,Loder S,Levi B. Heterotopic Ossification Following Upper Extremity Injury. Hand Clin.2017
May;33(2):363-373. doi: 10.1016/j.hcl.2016.12.013.
16. Hastings H 2nd, Graham TJ. The classification and treatment of heterotopic ossification about the elbow and
forearm. Hand Clin 1994 Aug;10(3):417-37.
17. Morrey BF, Bryan RS, Dobyns JH, Linscheid RL. Total elbow arthroplasty. A five-year experience at the
Mayo Clinic. J Bone Joint Surg Am 1981 Sep;63(7):1050-63.
18. Bruce HE, Harvey JP, Wilson JC Jr. Monteggia fractures. J Bone Joint Surg Am 1974 Dec;56(8):1563-76.
19. Boyd HB, Boals JC. The Monteggia lesion: a review of 159 cases. Clin Orthop 1969;66:94-100.
20. Reckling FW, Cordell LD. Unstable fracture-dislocations of the forearm. The Monteggia and Galeazzi
lesions. Arch Surg 1968 Jun;96(6):999-1007.
21. Ring D, Jupiter JB, Simpson NS. Monteggia fractures in adults. J Bone Joint Surg Am 1998
22. Ring D, Jupiter JB, Waters PM. Monteggia fractures in children and adults. J Am Acad Orthop Surg
1998 Jul-Aug;6(4):215-24.
23. Ring D, Tavakolian J, Kloen P, Helfet D, Jupiter JB. Loss of alignment after surgical treatment of
posterior Monteggia fractures: salvage with dorsal contoured plating. J Hand Surg Am 2004
24. Simpson NS, Goodman LA ,Jupiter JB. Contoured LCDC plating for the proximail ulna. Injury 1996
25. Egol KA, Tejwani NC, Bazzi J, Susarla A, Koval KJ. Does a Monteggia variant lesion result in a poor
functional outcome?: a retrospective study. Clin Orthop 2005;438:233-8.
26. Reynders P, De Groote W, Rondia J, et al. Monteggia lesions in adults: A multicenter Bota study. Acta
Orthop Belg 1996;62 Suppl 1:78-83.
27. Singh AP, Dhammi IK, Jain AK, Raman R, Modi P. Monteggia fracture dislocation equivalents--
analysis of eighteen cases treated by open reduction and internal fixation. Chin J Traumatol
28. Ring D. Monteggia fractures. Orthop Clin North Am. 2013 Jan;44(1):59-66.
29. Scolaro JA, Beingessner D. Treatment of Monteggia and transolecranon fracture-dislocations of the
elbow: a critical analysis review. JBJS Rev 2014; Jan 21;2(1) doi: 10.2106/JBJS.RVW.M.00049
30. Ozel O, Demircay E. Review of management of unstable elbow fractures. World J Orthop 2016; 7(1):
50-54 doi:
31. Sahajpal D, Wright TW. Proximal ulna fractures. J Hand Surg Am 2009 Feb;34(2):357-62.
doi: 10.1016/j.jhsa.2008.12.022.
32. Calderazzi F, Galavotti C, Nosenzo A, Menozzi M, Ceccarelli F. How to approach Monteggia-like lesions in
adults: A review. Ann Med Surg (Lond) 2018; Sep 25;35:108-116. doi: 10.1016/j.amsu.2018.09.027.
33. Wegmann K, Engel K, Skouras E, et al. Reconstruction of Monteggia-like proximal ulna fractures using
different fixation devices: A biomechanical study. Injury 2016;47:1636–1641.
34. Ablove RH, Moy OJ, Howard C, Peimer CA, S'Doia S. Ulnar coronoid process anatomy: possible
implications for elbow instability. Clin Orthop Relat Res 2006 Aug;449:259-61.
35. Givon U, Pritsch M, Levey O, et al: Monteggia and equivalent lesions: A study of 41 cases. Clin Orthop
Relat Res 1997 Apr;(337):208-15.

Most read articles by the same author(s)

1 2 3 > >>