Background Monteggia fractures and Monteggia-like lesions result after severe trauma and have high complication rates. Preliminary biomechanical studies suggested a correlation between ulnar fracture localization and clinical result. Objectives Key objective was to evaluate whether the site of the ulnar fracture can be correlated to clinical outcome after open reduction and internal stabilization. Methods In a retrospective, monocentric study 35 patients who underwent surgical treatment after suffering a Monteggia injury or Monteggia-like lesion were included. Fractures were classified according to Bado and Jupiter, the site of the fracture location at the proximal ulna and regarding the potential accompanying ligamentary injury. In a follow-up examination validated patient-reported outcome measures and functional parameters were evaluated. Furthermore, treatment strategy and complications were analysed. Results Mean patient age was 51.9 years (± 18.0). 69% were females (n = 24). Follow-up took place after 50.5 months (± 22.1). Fractures were classified according to Bado (I:2, II:27, III:4, IV:2). Bado II-fractures were further classified according to Jupiter (A:7, B:16, C:3, D:1). Cases were divided into subgroups depending upon the distance of the ulnar fracture site in respect to its distal endpoint (A: < 7 cm and B: > 7 cm). Average overall MEPS was 84.1 (± 19.0). Oxford elbow score and DASH were 37.2 (± 10.5) and 20.4 (± 20.5). Average extension capability reached − 7° (± 7.5). Mean flexion was 134.8° (± 19.7). Average pain according to visual analogue scale was 1.6 (± 1.9). We found no differences between the subgroups regarding the PROMs. Subgroup A displayed a worse extension capability (p = 0.027) and patients were significantly older (p < 0.01). Comparing patients with and without fracture of the radial head, we observed no differences. Patients with an accompanying injury of the coronoid process displayed higher pain levels (p = 0.011), a worse functionality (p = 0.027) and overall lower scoring in PROM. Conclusion The presented results suggest that in Monteggia fractures and Monteggia-like lesions, the localization of the ulna fracture can give a hint for its postoperative outcome. However, we could not confirm the hypothesis of an increasing instability in ulnar fractures located further distally (high severity of the potential ligamentous injury). Intraarticular fractures or injuries with a close relation to the joint have a worse prognosis, especially if the coronoid process is injured. Trial registration Registration was done with ClinicalTrials.gov under NCT05325268.

Die Arbeit beschäftigt sich mit der suprakondylären und y-kondylären Humerusfraktur im Kindesalter. Die suprakondyläre Humerusfraktur ist die häufigste Ellenbogenfraktur beim Kind, die y-kondyläre Fraktur ist der suprakondylären ähnlich, tritt aber nur selten auf. Es wurden 172 suprakondyläre und 6 y-kondyläre Humerusfrakturen retrospektiv untersucht. Dazu wurden die Daten von 55 ambulant und 123 stationär behandelten Kindern bezüglich Unfallursache, Therapie und Komplikationen ausgewertet. Die Röntgenbilder der stationären Patienten wurden nachbefundet. 32,5% der stationär behandelten Kinder konnten nachuntersucht werden. Die häufigste Unfallursache war ein Sturz aus der Höhe. Im Patientengut waren Frakturen nach Baumann Klassifikation I, II und III zu ähnlichen Teilen vorhanden. Häufigste Behandlungsverfahren waren, ggf. nach geschlossener Reposition, Ruhigstellung in Gipslonguetten oder Blountscher Schlinge, und geschlossene oder offene Reposition und anschließende Fixation mittels Kirschner Drähten. Die häufigsten Komplikationen waren primäre und sekundäre Nervenstörungen, Abweichung der Ellenbogenachse oder Bewegungseinschränkung nach Therapie. 68,5% der nachuntersuchten Patienten hatten ein exzellentes oder gutes Behandlungsergebnis. Die Analyse der Ergebnisse und deren Vergleich mit den Ergebnissen anderer Autoren zeigen Folgendes: Nicht dislozierte Extensionsfrakturen sollten in der Blountschen Schlinge ruhiggestellt werden. Dislozierte Frakturen müssen exakt und schonend, möglichst geschlossen, reponiert werden. Gekreuzte Kirschner Drähte bieten gute Stabilität. Primäre und sekundäre Nervenstörungen haben eine gute Prognose. Radiologische Hilfsmittel wie Baumannwinkel, Rotationsfehlerquotient und Epiphysenachsenwinkel geben nur eine Orientierung bei der Vermeidung von Abweichungen der Ellenbogenachse oder Bewegungseinschränkungen. Y-kondyläre Frakturen mit nur geringer Dislokation der Kondylenfragmente können primär wie suprakondyläre Frakturen behandelt werden. / This paper deals with supracondylar and y-condylar humerus fractures in childhood. The supracondylar humerus fracture is the most frequent elbow fracture in children, the y-condylar fracture is similar to the supracondylar one, but occurs only rarely. 172 supracondylar and 6 y-condylar humerus fractures have been analysed retrospectively. For that purpose data of 55 outpatients and 123 in-house treated children have been analysed with regard to the cause of accident, therapy and complications. The radiographs of the in-patients have been revaluated. 32.5% of the in-patients have been seen for follow-up. Most frequent cause of accident was a fall from a height. Within the group of patients, fractures that were classified to Baumann I, II and III occurred to equal rates. The treatments which were used mostly are immobilization in plaster casts or Blount´s loop, after closed reduction if necessary, and closed or open reduction followed by fixation by Kirschner wires. The most frequent complications were primary and secondary nerval disorders, deviation of the axis of the elbow or limitation of elbow function after therapy. 68.5% of the follow-up patients had an excellent or good outcome. The analysis of the results including their comparison to the results of other authors have led to the following conclusion: Nondisplaced extension fractures should be immobilized by Blount`s method. Displaced fractures have to be reduced accurately and sparing, if possible by closed reduction. Crossed Kirschner wires provide a good stability. Primary and secondary nerval disorders have got a good prognosis. Radiological tools like angle of Baumann, rotation error quotient and angle of epiphyseal axis only provide an orientation in avoiding deviation of elbow axis or limitation of elbow function. Y-condylar fractures with only slight dislocation of the condylar fragments can primary be treated like supracondylar fractures.