Introduction and objectives: This is a complex type of lesion that is frequently confused with Monteggia fracture. The objective of this paper is to analyse the experience of the Hospital Cl co San Carlos, in Madrid, in the management of the transolecranon fracture-dislocation of the elbow.

Methods and material: Between 1988 and 2001 a total of 23 cases have been revised, 7 of them presenting an oblique simple fracture of the olecranon and the other 16 cases with a comminute one (with fracture of the coronoid process in 9 patients). There was also a radial head fracture associated in 7 patients. Two cases showed ulnar nerve palsy before surgery. Fifthteen of the 21 cases were males and 8 females, with a mean age of 37, 3 years (range: 17–71). The mean follow up was of 56 months (range: 22–122 months). The etiology was a traffic accident (bicycle, motorbike, car) in the 47, 6%, a casual fall in the 23, 8%, a sport accident in the 14, 2% and a precipitation in the 9, 5%. All of them were treated with open reduction and internal fixation, with plate and screws in 17 cases and tension-band wiring in 4 patients. When a radial head fracture was associated, reconstruction was performed with screws in 5 cases and radial head excision in 1 case. Anatomic reduction was achieved in 11 cases.

Results: With the scale of Broberg and Morrey, excellent result was obtained in 6 cases, good in 8, fair in 6, and poor in the remaining 3. The most frequent complication was loss of motion (6 cases), followed by non-union in 2 cases (with hardware fatigue failure in 1 of them) and infection in other case. The two cases with preoperative ulnar nerve palsy resolved over a period of 4 months. Eleven patients needed a reoperation, performing a new internal fixation with bone grafting in 2 cases, a radial head prosthesis implanting in 1 case, and hardware removal in 8 cases.

Discussion and Conclusions: Although the transolecra-non fracture-dislocation of the elbow can be included in several classifications (AO, de Cotton, de Schatzker, etc.), none of them accommodate it satisfactorily, because of the complexity of the lesion. Our results show a statistically significative relation (p < 0.05) between the anatomic reduction obtained and excellent or good results and a high frequency of joint stiffness in this severe lesion.