Download PDF
Z Orthop Unfall 2021; 159(01): 102-119
DOI: 10.1055/a-0968-9383
CME-Fortbildung

Monteggia-Frakturen und Monteggia-like Lesions

Monteggia-fractures and Monteggia-like Lesions
Maria Mütze
,
Pierre Hepp
,
Christoph Josten
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Monteggia-Verletzungen umfassen osteoligamentäre Kombinationsverletzungen des proximalen Unterarms, die zu dauerhaft einschränkenden Folgezuständen führen können. Das Verständnis des Verletzungsbildes sowie die schrittweise Rekonstruktion, unter besonderer Beachtung von Anatomie und Biomechanik, stellt ein Grundpfeiler der erfolgreichen Versorgung dar. Dieser Beitrag soll besonders über die in der Literatur nicht eindeutig verwendeten Begrifflichkeiten aufklären und Behandlungsstrategien und erwartbare Prognosen aufzeigen.

Abstract

Monteggia lesions and Monteggia-like lesions involve ulna and radius injuries, which can not be successfully treated using the surgical principles of isolated fractures. Proximal ulnar fracture, radio-humeral dislocation, and additional dislocation in the proximal radioulnar joint result in the disintegration of the functional unit, and there is a complex injury across the elbow to the forearm, resulting in poor clinical outcomes. Thus, addressing all osteo-ligamentous injuries is essential for the long-term course.

Kernaussagen

  • Monteggia-Läsionen und Monteggia-like Lesions führen als Komplexverletzungen zur Destabilisierung der Ellenbogen- und Unterarmbiomechanik, sodass die Operation die Therapie der Wahl darstellt.

  • Die Adressierung aller osteoligamentärer Verletzungen ist für den Langzeitverlauf essenziell.

  • Das präoperative 3D-CT ist als Standarddiagnostikum obligat.

  • Der dorsale Zugang gilt als Standardzugang.

  • Geplante Osteosynthesematerialien als auch Rückzugsoptionen müssen zur Operation vorrätig sein.

  • Bado-II-Verletzungen, assoziierte Radiuskopffrakturen und Coronoidfrakturen gehen mit schlechterem klinischen Outcome einher.

Schlüsselwörter

Ellenbogen - Bandverletzung - Gelenkverletzung - Fraktur - Osteosynthese

Key words

elbow - ligament injury - joint injury - fracture - osteosynthesis


Publication History

Article published online:
21 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Bado JL. The Monteggia lesion. Clin Orthop Relat Res 1967; 50: 71-86
    PubMedGoogle Scholar
  • 2 Thiele K, Scheibel M, Gerhardt C. Monteggia- und Monteggia-like-Verletzungen. Obere Extrem 2018; 13: 2-13
    CrossrefPubMedGoogle Scholar
  • 3 Josten C, Freitag S. Monteggia and Monteggia-like Lesions: Classification, Indication, and Techniques in Operative Treatment. Eur J Trauma Emerg Surg 2009; 35: 296-304
    CrossrefPubMedGoogle Scholar
  • 4 Siebenlist S, Buchholz A, Braun KF. Fractures of the proximal ulna: current concepts in surgical management. EFORT Open Rev 2019; 4: 1-9
    CrossrefPubMedGoogle Scholar
  • 5 Jungbluth P, Tanner S, Schneppendahl J. et al. The challenge of Monteggia-like lesions of the elbow: mid-term results of 46 cases. Bone Joint J 2018; 100-B: 212-218
    CrossrefPubMedGoogle Scholar
  • 6 Laun R, Wild M, Brosius L. et al. Monteggia-like lesions – treatment strategies and one-year results. GMS Interdiscip Plast Reconstr Surg DGPW 2015; 4: Doc13 Im Internet (Stand: 07.12.2019): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4686841/
    PubMedGoogle Scholar
  • 7 Wegmann K, Engel K, Skouras E. et al. Reconstruction of Monteggia-like proximal ulna fractures using different fixation devices: A biomechanical study. Injury 2016; 47: 1636-1641
    CrossrefPubMedGoogle Scholar
  • 8 Giannicola G, Sacchetti FM, Greco A. et al. Management of complex elbow instability. Musculoskelet Surg 2010; 94 Suppl 1: S25-S36
    CrossrefPubMedGoogle Scholar
  • 9 Evans EM. Pronation injuries of the forearm, with special reference to the anterior Monteggia fracture. J Bone Joint Surg Br 1949; 31B: 578-588 illust.
    PubMedGoogle Scholar
  • 10 Tompkins DG. The anterior Monteggia fracture: observations on etiology and treatment. J Bone Joint Surg Am 1971; 53: 1109-1114
    CrossrefPubMedGoogle Scholar
  • 11 Penrose JH. The Monteggia fracture with posterior dislocation of the radial head. J Bone Joint Surg Br 1951; 33-B: 65-73
    CrossrefPubMedGoogle Scholar
  • 12 Jupiter JB, Leibovic SJ, Ribbans W. et al. The posterior Monteggia lesion. J Orthop Trauma 1991; 5: 395-402
    CrossrefPubMedGoogle Scholar
  • 13 Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 1954; 42: 123-132
    CrossrefPubMedGoogle Scholar
  • 14 Johnston GW. A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J 1962; 31: 51-56
    Google Scholar
  • 15 OʼDriscoll SW. Classification and evaluation of recurrent instability of the elbow. Clin Orthop Relat Res 2000; (370) 34-43
    CrossrefPubMedGoogle Scholar
  • 16 Müller LP, Hollinger B, Burkhart K. Expertise Ellenbogen. Stuttgart: Thieme; 2016
    Article in Thieme ConnectGoogle Scholar
  • 17 Korner J, Hoffmann A, Rudig L. et al. Monteggia-Verletzungen im Erwachsenenalter. Eine kritische Analyse von Verletzungsmuster, Management und Ergebnissen. Unfallchirurg 2004; 107: 1026-1040
    CrossrefPubMedGoogle Scholar
  • 18 Ring D, Jupiter JB, Simpson NS. Monteggia fractures in adults. J Bone Joint Surg Am 1998; 80: 1733-1744
    CrossrefPubMedGoogle Scholar
  • 19 Ring D. Monteggia fractures. Orthop Clin North Am 2013; 44: 59-66
    CrossrefPubMedGoogle Scholar
  • 20 Ries C, Wegmann K, Meffert RH. et al. Die Doppelplattenosteosynthese der proximalen Ulna. Oper Orthop Traumatol 2015; 27: 342-356
    CrossrefPubMedGoogle Scholar
  • 21 Hackl M. et al. Plate Osteosynthesis of proximal ulna fractures–a biomechanical micromotion analysis. J Hand Surg 2017; 42: 834.e1-834.e7
    CrossrefPubMedGoogle Scholar
  • 22 Ring D, Jupiter JB. Fracture-dislocation of the elbow. Hand Clin 2002; 18: 55-63
    CrossrefPubMedGoogle Scholar
  • 23 Hamaker M, Zheng A, Eglseder WA. et al. The adult Monteggia fracture: Patterns and incidence of annular ligament incarceration among 121 cases at a single institution over 19 years. J Hand Surg 2018; 43: 85.e1-85.e6
    CrossrefPubMedGoogle Scholar
  • 24 Burkhart KJ, Wegmann K, Müller LP. et al. Fractures of the radial head. Hand Clin 2015; 31: 533-546
    CrossrefPubMedGoogle Scholar
  • 25 Crönlein M, Zyskowski M, Beirer M. et al. Using an anatomically preshaped low-profile locking plate system leads to reliable results in comminuted radial head fractures. Arch Orthop Trauma Surg 2017; 137: 789-795
    CrossrefPubMedGoogle Scholar
  • 26 Van Glabbeek F, Van Riet RP, Baumfeld JA. et al. Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow. J Bone Joint Surg Am 2004; 86: 2629-2635
    CrossrefPubMedGoogle Scholar
  • 27 Hackl M, Müller LP, Leschinger T. et al. Ellenbogentotalendoprothetik bei traumatischen und posttraumatischen Knochendefekten. Orthopäde 2017; 46: 990-1000
    CrossrefPubMedGoogle Scholar
  • 28 Konrad GG, Kundel K, Kreuz PC. et al. Monteggia fractures in adults. Bone Joint J 2007; 89-B: 354-360
    PubMedGoogle Scholar
  • 29 Egol KA, Tejwani NC, Bazzi J. et al. Does a Monteggia variant lesion result in a poor functional outcome?: A retrospective study. Clin Orthop Relat Res 2005; 438: 233-238
    CrossrefPubMedGoogle Scholar
  • 30 Jupiter JB, Ring D. Operative treatment of post-traumatic proximal radioulnar synostosis. J Bone Joint Surg Am 1998; 80: 248-257
    CrossrefPubMedGoogle Scholar
  • 31 Foruria AM, Augustin S, Morrey BF. et al. Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna. J Bone Joint Surg Am 2013; 95: e66
    CrossrefPubMedGoogle Scholar
  • 32 Lee EK, Namdari S, Hosalkar HS. et al. Clinical results of the excision of heterotopic bone around the elbow: a systematic review. J Shoulder Elbow Surg 2013; 22: 716-722
    CrossrefPubMedGoogle Scholar
  • 33 Reynders P, De Groote W, Rondia J. et al. Monteggia lesions in adults. A multicenter Bota study. Acta Orthop Belg 1996; 62 Suppl 1: 78-83
    PubMedGoogle Scholar
  • 34 Cullen JP, Pellegrini VD, Miller RJ. et al. Treatment of traumatic radioulnar synostosis by excision and postoperative low-dose irradiation. J Hand Surg 1994; 19: 394-401
    CrossrefPubMedGoogle Scholar
  • 35 Wierer M, Huber-Wagner S, Mutschler W. Posttraumatische proximale radioulnare Synostose. Unfallchirurg 2012; 115: 451-456
    CrossrefPubMedGoogle Scholar
  • 36 Sotereanos DG, Sarris I, Chou KH. Radioulnar synostosis after the two-incision biceps repair: a standardized treatment protocol. J Shoulder Elbow Surg 2004; 13: 448-453
    CrossrefPubMedGoogle Scholar
  • 37 Manocha RHK, Kusins JR, Johnson JA. et al. Optimizing the rehabilitation of elbow lateral collateral ligament injuries: a biomechanical study. J Shoulder Elbow Surg 2017; 26: 596-603
    CrossrefPubMedGoogle Scholar