178. TYPE 2D MONTEGGIA ELBOW FRACTURE-DISLOCATIONS: PATTERN OF INJURY, SURGICAL TECHNIQUE OF FIXATION AND OUTCOME

Abstract

Purpose: To describe the pattern of injury, surgical technique and outcomes of Monteggia type IID fracture dislocations.

Method: Design: Retrospective review of prospectively collected clinical and radiographic patient data in orthopaedic trauma database with prospectively collected outcome scores. Setting: Level 1 university based trauma center. Patients / Participants: All patients with Monteggia type IID fracture dislocations admitted from January 2000 to July 2005. Intervention: Review of patient demographics, fracture pattern, method of fixation, complications, additional surgical procedures, and clinical and radiographic outcome measures. Main Outcome Measurements: Clinical outcomes: elbow range of motion, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand), PREE (Patient Rated Elbow Evaluation), complications. Radiographic outcomes: quality of fracture reduction, healing time, degenerative change and heterotopic ossification.

Results: Sixteen patients were included in the study. All fractures united. There were seven complications in 6 patients including 3 contractures with associated heterotopic ossification, 1 pronator syndrome and late radial nerve palsy, 1 radial head collapse and a DVT in the same patient and 1 with prominent hardware. Outcome scores were obtained on 11 patients at an average of 49 months (range 25 – 82 months) post-operatively. The average Quickdash score was 11 (range 0–43) and the average PREE score was 13 (range 0–34).

Conclusion: Monteggia IID fracture dislocations are complex injuries with a recurring pattern. Rigid anatomic fixation, early range of motion and avoidance of complications leads to a good outcome.