Monteggia-Frakturen und Monteggia-like Lesions

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.

Schlüsselwörter

Ellenbogen - Bandverletzung - Gelenkverletzung - Fraktur - Osteosynthese

Key words

elbow - ligament injury - joint injury - fracture - osteosynthesis

• Literatur

• 1 Bado JL. The Monteggia lesion. Clin Orthop Relat Res 1967; 50: 71-86
• 2 Thiele K, Scheibel M, Gerhardt C. Monteggia- und Monteggia-like-Verletzungen. Obere Extrem 2018; 13: 2-13
• 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
• 4 Siebenlist S, Buchholz A, Braun KF. Fractures of the proximal ulna: current concepts in surgical management. EFORT Open Rev 2019; 4: 1-9
• 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
• 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/
• 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
• 8 Giannicola G, Sacchetti FM, Greco A. et al. Management of complex elbow instability. Musculoskelet Surg 2010; 94 Suppl 1: S25-S36
• 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.
• 10 Tompkins DG. The anterior Monteggia fracture: observations on etiology and treatment. J Bone Joint Surg Am 1971; 53: 1109-1114
• 11 Penrose JH. The Monteggia fracture with posterior dislocation of the radial head. J Bone Joint Surg Br 1951; 33-B: 65-73
• 12 Jupiter JB, Leibovic SJ, Ribbans W. et al. The posterior Monteggia lesion. J Orthop Trauma 1991; 5: 395-402
• 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
• 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
• 15 OʼDriscoll SW. Classification and evaluation of recurrent instability of the elbow. Clin Orthop Relat Res 2000; (370) 34-43
• 16 Müller LP, Hollinger B, Burkhart K. Expertise Ellenbogen. Stuttgart: Thieme; 2016
• 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
• 18 Ring D, Jupiter JB, Simpson NS. Monteggia fractures in adults. J Bone Joint Surg Am 1998; 80: 1733-1744
• 19 Ring D. Monteggia fractures. Orthop Clin North Am 2013; 44: 59-66
• 20 Ries C, Wegmann K, Meffert RH. et al. Die Doppelplattenosteosynthese der proximalen Ulna. Oper Orthop Traumatol 2015; 27: 342-356
• 21 Hackl M. et al. Plate Osteosynthesis of proximal ulna fractures–a biomechanical micromotion analysis. J Hand Surg 2017; 42: 834.e1-834.e7
• 22 Ring D, Jupiter JB. Fracture-dislocation of the elbow. Hand Clin 2002; 18: 55-63
• 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
• 24 Burkhart KJ, Wegmann K, Müller LP. et al. Fractures of the radial head. Hand Clin 2015; 31: 533-546
• 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
• 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
• 27 Hackl M, Müller LP, Leschinger T. et al. Ellenbogentotalendoprothetik bei traumatischen und posttraumatischen Knochendefekten. Orthopäde 2017; 46: 990-1000
• 28 Konrad GG, Kundel K, Kreuz PC. et al. Monteggia fractures in adults. Bone Joint J 2007; 89-B: 354-360
• 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
• 30 Jupiter JB, Ring D. Operative treatment of post-traumatic proximal radioulnar synostosis. J Bone Joint Surg Am 1998; 80: 248-257
• 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
• 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
• 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
• 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
• 35 Wierer M, Huber-Wagner S, Mutschler W. Posttraumatische proximale radioulnare Synostose. Unfallchirurg 2012; 115: 451-456
• 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
• 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