A Monteggia fracture is a fracture of the proximal ulna in combination with a radial head subluxation. When a Monteggia fracture occurs, it is imperative that the length and the proper alignment of the ulna is restored so that the radial head can be reduced.
If the ulna is malaligned, then the radial head will remained subluxed. There are some cases where the fracture of the ulna is so comminuted, that restoration of the ulnar length will not be possible. In this case, it may not be known if the length of the ulna is restored or not.
So then how is this problem dealt with?
There is a certain technique that I use in the reconstruction of the ulna in cases where the ulna is too comminuted. During this technique, I start by opening the fractured ulna and approach the radial head. Then, I will reduce the radial head to the capitellum, and then reduce the ulna to the radius and make sure that the proximal radioulnar joint is anatomic. Once that joint is anatomic, I will pin it with either one or two K wires. I then transfix the ulna to the radial head. Since we know now that the radial head is reduced, the ulna should therefore be reduced as well because the radioulnar joint is reduced. So, we are temporarily transfixing the ulna to the radial head, which will help restore the proper length of the ulna. Once the proper length of the ulna is defined, then reconstruction of the ulna is simplified utilizing a dorsal ulnar plate. Next, the K wires are removed and the radioulnar joint is tested for stability. Occasionally, the K wires may be left in place for a few weeks if needed, in order to provide additional stability, then removed later on.
