Outcomes of Posterior Monteggia Variant Fractures Repaired Through a Trans-Olecranon Approach

PURPOSE: To evaluate the clinical and radiographic outcomes and complications following surgical treatment of adult posterior Monteggia fracture variants in which coexisting radial head and coronoid fractures were addressed through a single extensile posterior trans-olecranon approach. METHODS: We performed a retrospective review from January 1, 2010, to January 1, 2021, of all adult patients who underwent fixation of posterior Monteggia variant fractures with coexisting radial head and/or coronoid fractures through a trans-olecranon approach by a single surgeon. Patient records were reviewed for postoperative complications and radiographic outcomes. All patients were contacted to participate in a repeat clinical examination and functional assessment. RESULTS: Thirteen patients met the inclusion criteria, of which 7 agreed to participate. Final follow-up was conducted at an average of 49 months postoperatively. Six patients had a coexisting radial head fracture, 1 had a radial neck fracture, and all 7 patients had a coronoid fracture. All 7 coronoid fractures were repaired, 2 patients had internal fixation of the radial head, and 5 had radial head replacement. Four patients underwent reoperation. There were no cases of infection or heterotopic ossification, and all patients achieved radiographic bony union. The average final range of motion was 13°–133° flexion-extension (range: 0°–30° extension to 125°–145° flexion), 76° pronation (range: 70°–90°) and 72° supination (range: 60°–90°). The average Mayo Elbow Performance Score was 86 (range: 70–100), average Visual Analog Scale score was 1.4 (range: 0–3), and average Disabilities of the Arm, Shoulder, and Hand score was 9.8 (range: 0.83–35.83). CONCLUSIONS: Use of a single extensile trans-olecranon exposure offers reliable visualization and access to all bony structures requiring repair while minimizing soft tissue disruption. Patients treated with this trans-olecranon surgical approach demonstrate satisfactory clinical and radiographic outcomes with low rates of heterotopic ossification, nonunion, and infection. LEVEL OF EVIDENCE: Therapeutic IV.