Monteggia lesions and their complicating nerve damage.

Monteggia lesions and their equivalents are reviewed on the basis of the literature and 14 cases encountered over a 10-year period. Mention is made of aetiology, classification into types and treatment. For the 14 cases in this study the mean follow-up time was 6 years. Likewise, mention is made of the relationship between anatomy and the neuropathy which is a frequent complication in Monteggia lesions. In particular the ramus profundus of the radial nerve is exposed to injury but other nerves may also be involved. It is concluded that Monteggia lesions and their equivalents are relatively rare, a fact that may give rise to therapeutic problems. In adults the lesions often lead to permanent restriction of movement. Patients should be followed up for a long time with a view to early recognition and treatment of ulnar pseudoarthrosis. In case of neurological complications the intiial treatment should be conservative and expectant since there is usually no lesion to the nerve in continuity, but if function has failed to return after 8 weeks, surgical exploration is required with decompression in view.