Monteggia fractures and the Bado CLASSIFICATION: AN urban trauma center experience.

Background: There are conflicting reports regarding the incidence of Monteggia fractures by Bado type and their associated risks of nerve and vascular injury and other complications. Methods: A registry was queried at a level I trauma center for Monteggia fracture codes. A retrospective chart and radiographic review were then conducted to correctly identify Monteggia fractures. The primary outcome was incidence by Bado type with secondary outcomes being associated injuries. Results: 69 patients sustained Bado I (42), Bado II (15), Bado III (8), and Bado IV (4) injuries. 83 % had a high-energy mechanism. 7 % had vascular injuries, 32 % were open, 13 % had a radial head fracture, 10 % had neurological deficits, 0 % had compartment syndrome, 1 % required open reduction of the radiocapitellar joint, 1 % developed malunion, and 9 % developed nonunion. 61 % were Bado I injuries. However, it was more common for Bado III fractures to be open (p = 0.018), and for Bado II fractures to involve radial head fractures (p = 0.008). Neurologic deficits were seen in Bado I, II, and IV injuries with 5/7 of these injuries in Bado I patients, although not significant (p = 0.600). Three nerve injuries were transections without recovery. Five vascular injuries were seen, none required revascularization. One Bado I required open reduction of the radiocapitellar dislocation. Malunion and nonunion were significant for Bado II (p = 0.031). Conclusion: Bado I are the most common type in this mostly high-energy cohort. There were no significant differences in the incidence of associated neurologic or vascular injuries between Bado types. There were significantly more nonunion/malunion and radial head fractures in Bado II and greater percentage of open injuries in Bado III. No patients developed compartment syndrome. Twelve patients had nerve or vascular injuries, 32 % were open fractures, and 6 had nonunions, underscoring that this is not a benign injury.