Monteggia fracture-dislocation fixation is an operation to fix a fracture of the ulna combined with dislocation of the radial head at the elbow. Accurate ulna fixation is critical — when the ulna length and alignment are restored, the radial head usually reduces spontaneously.
An incision is made over the ulna. The ulna fracture is anatomically reduced and fixed with a plate and screws. Once the ulna is restored to its correct length and alignment, the radial head is checked — it typically reduces into the joint spontaneously. If the radial head remains dislocated, the annular ligament may need repair. The operation takes one to one and a half hours.
All Monteggia fracture-dislocations in adults require surgery. Without accurate ulna fixation, the radial head remains dislocated, causing chronic elbow instability and loss of forearm rotation.
In children, many Monteggia injuries can be managed with closed reduction and casting. In adults, surgical fixation is the standard treatment.
X-rays must include the full forearm and elbow to identify the radial head dislocation. CT may be helpful for complex patterns.
Restoration of elbow stability and forearm rotation. When recognised and treated promptly, outcomes are generally good.
Some loss of terminal extension is common.
Mild loss of pronation or supination.
May require further surgery.
Temporary weakness of finger extension. Usually recovers.
Ulna fracture failing to heal.
Bone formation limiting elbow movement.
Wound infection.
General or regional anaesthesia.
Early elbow movement is critical. Splint between exercise sessions for two to four weeks. Active forearm rotation from the first week. Return to desk work at two to four weeks. Full recovery three to six months.
X-rays at two weeks, six weeks, and three months.
A missed Monteggia (chronic radial head dislocation) is much harder to treat and may require radial head excision or complex reconstruction. This is why full forearm X-rays including the elbow are essential for all forearm fractures.