Exploration of the outcomes of different operative methods for old Monteggia fractures in children
HUANG Jin-cheng
LIAN Hong-kai
BAI Yu
CHENG Fu-li
JING Xiao-bo
ZHANG Jing-yi
MA Fu-qiang
Abstract：Objective To explore the outcomes of 3 different operative methods in the treatment of old Monteggia fractures. Methods From 2006 to 2012, 55 patients with old Monteggia fractures underwent surgical treatment in our Department, whose clinical data were retrospectively studied. According to the Bado classiifcation system, there were 33 cases of type I, 2 cases of type II and 20 cases of type III. On admission, 7 children were diagnosed with radial nerve injury. Before the treatment, there were no signiifcant differences among the 3 groups in clinical data such as the age, gender, injury time, fracture type, with or without nerve injury and so on ( P>0.05 ), which were comparable. All patients were divided into 3 groups according to their different operative methods. Group A ( n=24 ) were treated with modiifed Hirayama ulnar osteotomy and annular ligament reconstruction with the palmaris longus tendon. Group B ( n=17 ) were treated with modiifed Hirayama ulnar osteotomy and Kirschner wire ( K-wire ) ifxation of the humeroradial joint. Group C ( n=14 ) were only treated with modiifed Hirayama ulnar osteotomy. No special treatment was given to the children with radial nerve injury. Results 51 patients were followed up for an average duration of 18.27 months ( range;7-32 months ), and the follow-up rate was 92.7%. There were 23 cases in Group A, 16 cases in Group B and 12 cases in Group C. All incisions were primary healing, and fracture union was achieved on schedule. The symptoms of radial nerve injury were relieved. 2 patients in Group A had bad complications ( 8.7%). Limited forearm rotation occurred to 1 patient ( 75° of pronation, 45° of supination ), and radial head subluxation to the other. 1 patient in Group B had bad complications ( 6.3%), whose K-wire was broken 3 weeks after the operation.6 patients in Group C had bad complications ( 50.0%). Radial head subluxation occurred to 2 patients, and radial head dislocation to the other 4 patients. The incidences of adverse reaction in both Group A and Group B were lower than that in Group C, and the differences were statistically signiifcant ( P<0.017 ). The incidence of adverse reaction in Group A was lower than that in Group B, and the differences were not statistically signiifcant ( P=1.000 ). The Mayo elbow performance index ( MEPI ) in Group A was increased by 30 points on average 6 months after the operation, when compared with that before the operation. This index was higher than that in both Group B ( 16.3 points ) ( P=0.000 ) and Group C ( 24.4 points ) ( P=0.048 ), and the differences were statistically signiifcant. The MEPI in Group B was increased by 16.3 points on average, when compared with that before the operation. This index was lower than that in Group C ( 24.4 points ) ( P=0.001 ), and the differences were statistically signiifcant. Conclusions The modiifed Hirayama ulnar osteotomy plus annular ligament reconstruction with the palmaris longus tendon is superior to only modified Hirayama ulnar osteotomy and modified Hirayama ulnar osteotomy plus K-wire fixation of the humeroradial joint in the treatment of old Monteggia fractures in children.
Keywords：FracturesboneUlna fracturesFracture ifxationPeripheral nerve injuriesWounds and injuries
Publication Date：2013-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 526-530 )