What is the recommended treatment procedure for a Monteggia fracture?

From the Research

The recommended treatment for a Monteggia fracture involves immediate surgical intervention with open reduction and internal fixation (ORIF) of the ulnar fracture, followed by reduction of the radial head dislocation, as this approach has been shown to improve outcomes and reduce complications in recent studies, such as 1. The procedure typically involves the following steps:

• Open reduction and internal fixation of the ulnar fracture using a plate and screws to restore anatomical alignment, which usually leads to spontaneous reduction of the radial head, as noted in 2.
• If the radial head remains dislocated after ulnar fixation, direct reduction and possible temporary pinning of the radiocapitellar joint may be necessary, as discussed in 3.
• Post-operatively, the arm is immobilized in a long arm cast or splint at 90 degrees of elbow flexion for 2-3 weeks, followed by protected range of motion exercises, as described in 4.
• Physical therapy should begin after immobilization to restore elbow function, focusing on flexion-extension and pronation-supination movements, as recommended in 5. Some key considerations in the treatment of Monteggia fractures include:
• Early surgical intervention is crucial as delayed treatment can lead to poor outcomes including chronic radial head dislocation, elbow instability, and post-traumatic arthritis, as highlighted in 2.
• In children, closed reduction and casting may be sufficient if the fracture is stable, but surgical intervention is often required in adults due to the inherent instability of these fractures and the importance of restoring the ulnar length and alignment to maintain proper radiocapitellar joint mechanics, as noted in 1.
• The use of plating and forearm fascial slip annular ligament reconstruction has been shown to be a effective method of treatment in some cases, as described in 1. The goal of treatment is to restore the anatomy and stability of the forearm ring, as discussed in 4, and to achieve excellent functional outcomes, as reported in 1.