Abstract
Background
Report on surgical management of ulnar impaction syndrome secondary to chronic Monteggia
fractures are limited, and optimal techniques and outcomes remain unclear. Herein,
we report a case in which preoperative stress evaluation followed by diaphyseal-level
ulnar-shortening osteotomy led to favorable clinical outcomes.
Case Description
A 54-year-old woman with a childhood forearm injury presented with ulnar-sided wrist
pain. Imaging revealed ulnar impaction syndrome with foveal triangular fibrocartilage
complex (TFCC) injury. An asymptomatic anterior radial head dislocation, consistent
with a chronic Monteggia fracture, was also identified. Conservative management was
unsuccessful; thus, she underwent diaphyseal-level ulnar-shortening osteotomy and
TFCC reconstruction. The dislocated radial head remained stable under longitudinal
stress, justifying the ostomy alone without radial head intervention. Postoperatively,
distal radioulnar joint instability resolved immediately. At 18 months, the radial
head had not migrated proximally, and the patient was pain-free.
Clinical Relevance
Ulnar-shortening osteotomy for ulnar impaction syndrome secondary to chronic Monteggia
fracture raises concerns about proximal radial head migration through the interosseous
membrane. However, our findings indicate that when the dislocated radial head remains
stable under longitudinal stress, diaphyseal ulnar-shortening osteotomy may be an
effective treatment option.
Keywords
chronic Monteggia fracture - ulnar impaction syndrome - ulnar-shortening osteotomy
- triangular fibrocartilage complex - reconstruction
