Affiliations: [a] Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany | [b] Department of Orthopedics and Trauma Surgery, St. Josef-Hospital Bochum, Katholisches Klinikum Bochum, Ruhr-University Bochum, Germany | [c] Department of Trauma Surgery, Klinikum Augsburg, Augsburg, Germany
Correspondence:
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Corresponding author: Lars Eden, Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Oberduerrbacher Straße 6, 97080 Wuerzburg, Germany. Tel.: +49 931 37023; Fax: +49 931 37009; E-mail: Eden_L@ukw.de.
Note: [1] First and second authors contributed equally to this work.
Abstract: BACKGROUND: Monteggia-like lesions are rare injuries. We retrospectively reviewed 40 consecutive patients with Monteggia-like lesions treated at a level I trauma center from 2009 to 2016. Clinical results were evaluated with a focus on the use of modern locking plates. OBJECTIVE AND METHODS: Twenty-eight patients had Bado type II fractures, 11 had Bado type I, and 1 had Bado type III. All patients were treated by plate fixation of the ulna with a locking compression plate or double mini-plates. Fixation or replacement was performed for radial head fractures. We characterized all fractures and recorded the range of motion (ROM); 100-point visual analog scale (VAS) scores for pain and function; Disabilities of the Arm, Shoulder and Hand (DASH) score; and Mayo Elbow Performance Score (MEPS). A follow-up rate of 78% was reached at an average of 36 months (range, 12–95 months). RESULTS: Stable fixation without recurrent instability was accomplished. The average ROM for flexion reached 130∘ with an extension deficit of 13∘. The sum of supination and pronation was 136∘. The VAS scores for pain and function were 20 and 75, respectively. The average MEPS and DASH scores were 84 and 28, respectively. Bado type I fractures had better outcomes for all variables, especially forearm rotation (p< 0.05). The complication rate was 22.5% and revision rate was 17.5%. CONCLUSION: This fracture repair technique can safely achieve good and excellent outcomes in most cases and is partly superior to previously published techniques. However, Bado type II fractures still have a risk of poor results.
