Objective To establish better treatment for Monteggia fracture by evaluating the operative effect and function rehabilitation in children.Methods From 1994 to 2001, 78 children with Monteggia fracture ( 30 cases of new fracture, 48 cases of old fracture) were treated with open reduction and internal fixation.The patients were randomly divided into two groups. In the first group( 45 cases, 16 new and 29 old), radiohumeral joint was fixed with a Kirschner wire after reduction and without fixation of ulna fracture; in the second group( 33 cases, 14 new and 19 old), both radiohumeral joint and ulna fracture were fixed with Kirschner wire. Two groups were treated with plastersplint after operation. The effect of operation was evaluated according to the function criteria for bending elbow and rotation of forearm. Results All patients were followed up 6 months to 7 years( 4.6 years on average). All wound healed well without bone nonunion, delayed union and infection after operation. In the first group, 37 cases were rated as excellent, 5 good and 3 poor. The effective rate was 93.3%. In the second group, 22 cases were rated as excellent, 7 good and 4 poor. The effective rate was 87.9%.There was no significant difference between two groups( P＞0.05). Conclusion Surgical treatment is the choice for Monteggia fracture in children. It should be treated with single Kirschner wire fixing after open reduction of radiohumeral and plaster-splint .This method is simple, safe and has satisfactory results in fracture healing and function rehabilitation after operation.
ObjectiveTo evaluate the short-term effectiveness of transarticular fixation of humeroradial joint by Kirschner wire (or combined with proximal ulnar osteotomy) for old radial head dislocation after open reduction of the radial head in children. MethodsA retrospective analysis was made on the clinical data of 25 children with old radial head dislocation between January 2008 and December 2010.There were 18 boys and 7 girls,aged 2 years and 5 months to 9 years and 5 months (mean,5 years and 11 months).The left side was involved in 13 cases,and the right side in 12 cases.The interval of injury and operation was 3 weeks to 30 months (median,14 months).The main presentations were abnormal mass in the anterior elbow,motion limitation of forearm pronation,and dorsiflexion inability of wrist and thumb.Three patients had radial nerve lesion.In 23 patients with simple radial head dislocation,transarticular fixation of humeroradial joint by Kirschner wire was used after open reduction of the radial head; in 2 patients with Monteggia fracture,transarticular fixation by Kirschner wire and additional proximal ulnar osteostomy were used. ResultsA primary healing of incision was obtained,without complication of infection,joint stiffness,or radial head necrosis.Twenty-four patients were followed up 29-58 months (mean,44.3 months); one case had re-dislocation,failed to be followed up at 2.5 months postoperatively.In 3 patients with radial nerve injury,neural function recovery was obtained in 2 cases,and no improvement was observed in 1 case.Twenty-three had no pain,no deformity,and no motion limitation of elbow and forearm except 1 patient with no improvement of neural function.The mean range of montion (ROM) of elbow flexion was 134° (range,125-140°),and the mean ROM of extension was -4° (range,-8-0°); the mean ROM of forearm pronation was 74° (range,65-80°),and the ROM of supination was 90°.According to Mackay's criteria,the results were excellent in 22 cases,good in 1 case,and poor in 1 case at 2 years after operation. ConclusionThe transarticular fixation of humeroradial joint by Kirschner wire (or combined with proximal ulnar osteotomy) is a feasible and effective method to treat old radial head dislocation in children based on a short-term follow-up.
Objective To investigate the classification and treatment of Monteggia equivalent fractures in children. Methods A retrospective analysis was made on the clinical data of 35 cases of Monteggia equivalent fractures between January 2008 and January 2012. There were 17 boys and 18 girls with an average age of 7 years and 5 months (range, 1 year and 2 months to 14 years and 11 months). The causes of injury were tumbling injury in 25 cases, falling injury in 3 cases, and sport injury in 7 cases. The disease duration from injuries to admission ranged from 1 hour to 16 days (median, 28 hours). According to the criteria of self-made classification, there were 22 cases of type I (ulnar fracture with radial neck fracture or proximal radial epiphysis injury), 2 cases of type II (posterior elbow dislocation with radial neck fracture or proximal radial epiphysis injury), 10 cases of type III (ulnar fracture and/or olecranon fracture with humeral lateral condylar fracture), and 1 case of type IV (fractures of radius and ulna with radial neck fracture or proximal radial epiphysis injury). All patients were treated by open reduction and internal fixation/external fixation. Results All incisions healed by first intention without infection. Thirty-four cases were followed up 14 months on average (range, 12-18 months). All fractures healed at 2.5 months on average (range, 6 weeks to 5 months). According to Hospital for Special Surgery (HSS) score system, the results were excellent in 29 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 94%. No cubit varus/valgus or delayed ulnar nerve injury was observed. Conclusion New self-made classification is simple and easy to remember, and it is helpful to reduce omission diagnose rate and select therapeutic methods. Surgery is an effective method to treat Monteggia equivalent fractures.
ObjectiveTo investigate the effectiveness of a modified surgical treatment of old Monteggia fracture. MethodsBetween March 2006 and December 2013, 40 cases of old Monteggia fracture were treated with modified operation. Modified operation procedure included expanding excision of pedicled forearm fascia flap for reconstruction of the annular ligament and repair of elbow radial lateral collateral ligament complex and extending osteotomy of the ulna, callus replantation, and internal fixation with steel plate. There were 26 boys and 14 girls, aged 2-10 years with an average age of 4 years. Injury was caused by falling in 24 cases, by traffic accident in 8 cases, and by falling from height in 8 cases. The disease duration was 2-11 months (mean, 4 months). Four patients had combined radial nerve palsy. ResultsIncision healed by first intention after operation, without early complication of radial nerve palsy, fascial compartment syndrome, or decreased hand extensor muscle strength. All the children were followed up 1-5 years (mean, 2.5 years). X-ray films showed fracture healing, and the healing time was 10-20 weeks (mean, 15 weeks). During follow-up, 3 cases had re-dislocation. Neither hand dysfunction caused by hand muscle adhesion nor radial head bottleneck shape change was found. On the basis of the functional evaluation criteria by Mackay, the results were excellent in 32 cases, good in 5 cases, and poor in 3 cases; the excellent and good rate was 92.5% at last follow-up. ConclusionThe modified surgical treatment of old Monteggia fracture is an effective method, with good matching of humeroradial joint and without internal fixation of the humeroradial joint.
From 1980 to 1992, 62 cases of Monteggias fracture in children were treated byoperation, in which were 18 cases were fresh, 44 old. The following procedure performed separately: the reduction of the head of radius; the use of internal fixation following anatomical reduction of the ulna or the osteotomy of the ulna and elongation; the repair or reconstruction of annular ligament of the superior radioular joint. From the last follwup, 93 percent was excellent in the clinical result. The operative method was introduced briefly. The importance of earlydiagnosis and prompt effective treatment of Monteggias fracture in children was discussed. The key to prevent redislocation of the head of radius was that rigid fixation of ulna and repair or reconstruction of the annular ligament of radius were important. It is also important to improve curative effect that early functional movement after operation was mandatory for good operative results.
ObjectiveTo explore the effectiveness of annular ligament reposition and repair via Henry’s approach for Monteggia fracture in children.MethodsA clinical data of 21 children with Monteggia fractures was retrospectively analysed, who underwent open reduction of the radial head and annular ligament reposition and repair via Henry’s approach between May 2015 and July 2019. There were 11 boys and 10 girls with an average age of 8 years and 1 month (range, 4 years and 5 months to 14 years and 4 months). The fracture was caused by falling in 17 cases and by falling from height in 4 cases. There were 16 fresh fractures and 5 old fractures. The Monteggia fractures were rated as Bado typeⅠin 14 cases and Bado type Ⅲ in 7 cases. Preoperative MRI examination and intraoperative observation confirmed that the annular ligament was intact. After operation, the fracture healing, elbow range of motion (ROM), and complications were recorded, and the effectiveness was evaluated according to the Mackay’s function scoring system.ResultsThe incisions healed by first intention after operation, and there was no complication such as radial nerve injury. All children were followed up 12-25 months, with an average of 15 months. No dislocation or subluxation of the radial head occurred after operation. At last follow-up, the ROM of elbow flexion and extension of the children with old fractures increased from (92.6±11.2)° before operation to (123.6±11.6)°, and the ROM of forearm rotation from (96.8±11.8)° to (129.8±5.9)°; the differences between pre- and post-operation were significant (t=7.672, P=0.002; t=9.487, P=0.001); the ROM of elbow flexion and extension of the children with fresh fractures was 139°-156° (mean, 145°); the ROM of forearm rotation was 158°-168° (mean, 162°). According to Mackay’s criteria, 17 cases were excellent and 4 cases were good, with an excellent and good rate of 100%. X-ray film examination showed no nonunion, heterotopic ossification, or loosening of internal fixation after operation. The ulnar fracture and the ulnar osteotomy healed in all cases.ConclusionThe annular ligament in Monteggia fractures in children is intact. Compared with the reconstruction of the annular ligament, the reposition and repair of the annular ligament via Henry’s approach is closer to the original anatomical state of the annular ligament and has the advantages of less trauma and fewer complications.