Ulnar Impaction Syndrome Secondary to Chronic Monteggia Fracture: A Case Report

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

Author's Contributions

M.K. and S.K. designed the study and performed the operation. M.K., S.K., Y.I., and H.A. wrote the manuscript.

Ethical Approval

This retrospective study was approved by the institutional review board of Gifu University Graduate School of Medicine (2018-217).

Patients' Consent

Informed consent was obtained from all patients included in the study.

Publication History

Received: 26 April 2025

Accepted: 16 June 2025

Article published online:
03 July 2025

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