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Treatment of Monteggia and Transolecranon Fracture-Dislocations of the Elbow: A Critical Analysis Review

The uninjured elbow is an inherently stable joint. The skeletal articulations, surrounding capsuloligamentous structures, and muscular attachments maintain stability. The primary stabilizers of the elbow are the coronoid process, olecranon, trochlea, and collateral ligaments1. Traumatic dislocations without substantial skeletal injury are considered simple and usually do not require operative repair. In contrast, complex dislocations, which are associated with fracture and may involve one or more of the primary stabilizing structures of the elbow, are unstable and typically require operative reduction and internal fixation to achieve stability.

Complex elbow fracture-dislocations follow a subluxation or dislocation event. These injuries range from ulnohumeral dislocations with radial head and coronoid process fracture (“terrible triad” injuries) to ulnar fractures with an associated injury of the proximal part of the radius, proximal radioulnar joint, radiocapitellar joint, or ulnohumeral joint. Monteggia injuries involve a proximal ulnar fracture with disruption of the proximal radioulnar joint. Transolecranon fracture-dislocations involve a proximal ulnar fracture at the greater sigmoid notch and anterior dislocation of the elbow, without disruption of the proximal radioulnar joint. Some fracture-dislocations do not follow either pattern but have features consistent with one or the other that help to guide treatment. The focus of this article …