The Journal of Bone and Joint Surgery, Vol 64, Issue 6 857-863, Copyright © 1982 by Journal of Bone and Joint Surgery, Inc
Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions)
FW Reckling
Forty-nine Monteggia and forty-seven Galeazzi lesions were treated over a
twenty-five-year period. I used Bado's criteria to evaluate the results in
the Monteggia lesions. In all of the children in the series either closed
or open reduction yielded good results, while the results of treatment of
the Monteggia fractures in the adults in the study varied. The best results
were obtained in Type-I lesions treated by open anatomical reduction,
internal stabilization of the ulnar fracture, and closed reduction of the
radial head. Factors leading to poor results in Type-I lesions were failure
to obtain anatomical reduction of the ulna, heterotopic ossification
including synostosis of the proximal parts of the radius and ulna, and
persistence or recurrence of dislocation of the radial head. In patients in
whom the radial head could not be reduced by closed methods, the radial
head was buttonholed through the joint capsule and the annular ligament was
displaced but not ruptured. I have not found that reconstruction of the
annular ligament is necessary in the treatment of acute Monteggia
fractures. In the Type-II, III, and IV lesions in this series, fair results
were the rule. The results of closed reduction of the classic Galeazzi
fractures in the adults in this series were not good, due to malunion of
the radius and persistent derangement of the distal radio-ulnar joint. The
seventeen patients who were treated with accurate reduction and internal
fixation of the fractured radius and immobilization of the forearm in full
supination for six to eight weeks obtained good results.
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