Study of the Various Factors Involved in Monteggia Fractures Treated by Open Reduction and Internal Fixation in Government Medical College, Trichur

BACKGROUND The various factors involved in Monteggia fractures treated by open reduction and internal fixation (ORIF) were studied in patients presenting to Government Medical College, Trichur. Its distribution based on age, gender, and nature of trauma, were observed in the patients. METHODS This study was a prospective descriptive study, conducted in Department of Orthopaedics, Medical College, Thrissur from 1, January, 2016 to 1, July, 2017. Patients were assessed according to age, sex, side of injury, co-morbidities and final functional assessment was made according to Broberg and Morrey score. A total of 37 patients were observed. The patients were assessed, deemed fit for the study, and subjected to operation. Radial head reduction, fixation if needed, then ulna fracture was opened, reduced, and fixed with plate and screws. Postoperative plaster slab was applied, then converted to full above elbow cast, and retained for as long as needed. Post-operative mobilization was by home physiotherapy only. RESULTS Our study showed that open reduction and internal fixation of ulna outcome in Monteggia fractures leads to good elbow function and minimal loss of physical capacity. Immobilization of more than 2 months have very high chances of elbow stiffness. Early active mobilization after surgery is necessary for good functional outcome. Other than mild stiffness and loss of range of motion in some cases, very few other complications were found in our series. CONCLUSIONS Rigid internal fixation of ulna and early active mobilization is the key to achieve a good functional outcome and minimal loss of physical capacity in Monteggia fractures. Very few of the complications that were described in the literature were seen in the study. Even with restricted resources and minimal facilities, almost no permanent or debilitating morbidity or complications were seen in our series. Early active mobilization after surgery was the most important deciding factor for good functional outcome. Prolonged immobilization of more than one month consistently produces poor results. KEYWORDS Monteggia, Broberg and Morrey, Bado Classification, Internal Fixation, Ulna Fracture