Fractures of the forearm make up about 10-14% of all fractures. Monteggia lesions account for 1-6% of the forearm fractures. The eponym “Monteggia fracture” is a term used for fracture of ulnar proximal shaft with concomitant dislocation of the radial head in the proximal radioulnar joint [1]. Its clinical symptoms are: pain, edema, local sensitivity, friction between bone fragments, deformation of the limb, loss of function in elbow joint and the forearm. Radiographs in AP and lateral views of the entire forearm, with wrist and elbow joint, are mandatory for successful diagnosis [2]. There are four types of fractures in the Bado classification system of the Monteggia lesion [3]. All Monteggia fractures in adults require surgical procedure of open reduction and internal fixation as a method of choice [4]. Delayed bone adhesion, nonunion, synostosis, instability of the radial head, nerve damage and restriction of movement are main complications of surgical intervention. We present a case of a 55-year-old patient with Monteggia fracture of a right forearm with a complication of a nonunion of the ulnar shaft, despite undergoing surgical procedure of open reduction and internal fixation. We describe consecutive methods of treatment that resulted in complete bone adhesion. Nonunion typically occurs due to technical mistakes in initial surgical intervention. Application of the correct reparative technique with autogenous bone graft and compression plates allows to fully heal nonunion of the bone.

forearm shaft; Monteggia fracture; open reduction internal fixation; compression plate; nonunion; bone graft

Thomas P. Rüedi, Richard E. Buckley, Christopher G. Moran AO Principles of Fracture Management. Vol. II, Thieme. - 2007. p. 490

Kenneth A. Egol, Kenneth J. Koval, Joseph D. Zuckerman Handbook of Fractures. Vol. I, Lippincott Williams & Wilkins. - 2010. p. 328

Bado JL. The Monteggia lesion. Clin Orthop Relat Res 50. -1967. pp. 71-86.

James P. Stannard, Andrew H. Schmidt, Philip J. Kregor Surgical Treatment of Orthopaedic Trauma. Vol. II, Thieme. - 2007. p. 447

Chapman MW, Gordon JE, Zissimos AG. Compression – plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg Am. - 1989, 71. pp. 159-169

Grace TG, Eversmann WW Jr. Forearm fractures treatment by rigid fixation with early motion. J Bone Joint Surg Am. -1980, 62, pp. 433-438

Ross ERS, Gourevitch D, Hastings GW, Wynn – Jones CE, Ali S. Retrospective analysis of plate fixation of diaphyseal fractures of the forearm bones. Injury. - 1989, 20. pp. 211-214

Perren SM. Evolution of the internal fixation of long bone fractures: review article. J Bone Joint Surg Br. - 2002, 84. pp. 1093-1110

Boyd HB, Boals JC. The Monteggia lesion. A review of 159 cases. Clin Orthop. - 1969, 66. pp. 94-100

McQueen MM, Gaston P, Court – Brown CM. Acute compartment syndrome: who is at risk? J Bone Joint Surg Br. - 2000, 82. pp. 200-203

Ghobrial TF, Eglseder WA Jr, Bleckner SA. Proximal ulna shaft fractures and associated compartment syndromes. Am J Orthop. - 2001, 30. pp. 703-707

Morrey BF, An KN. Functional evaluation of the elbow. In: Morrey BF, editor. The elbow and its disorders. 3rd ed. Philadelphia: WB Saunders. -2000. p. 82.

Kellam James F, Meinberg Eric G, Agel Julie, Karam Matthew D, Roberts Craig S. Introduction: Fracture and Dislocation Classification Compendium—2018 International Comprehensive Classification of Fractures and Dislocations Committee. Journal of Orthopaedic Trauma. - January 2018. 32. S1-S10

Gebuhr P, Holmich P, Orsnes T. Isolated ulnar shaft fractures: comparison of treatment by functional brace and long arm cast. J Bone Joint Surg Br. - 1992, 74. pp.757-759

Memeo A, Verdoni F, De Bartolomeo O, Albisetti W, Pedretti L. A new way to treat forearm post-traumatic non-union in young patients with intramedullary nailing and platelet-rich plasma. Injury. - 2014 Feb, 45(2). pp.418-423

Sisk, Sisk TD. Compression-plate fixation for fractures of the radius and ulna. Strat Orthop. - 1982, 2:1

Simpson NS, Goodman LA, Jupiter JB. Contoured LCDC plating of the proximal ulna. Injury. -1996. 27. p.411

Ring D, Jupiter JB, Simpson S. Monteggia fractures in adults. J Bone Joint Surg Am. -1998. 80. pp. 1733-1744