The analysis for the treatment of Monteggia's fracture in children / 中华骨科杂志

ABSTRACT

Objective To analyze the clinical outcomes after different treatments for the Monteggia's fracture in children. Methods From January 1991 to December 2001, a total of 128 children with Monteggia's fracture were reviewed, there were 91 males and 37 females, the average age was 7.4 years (range, 2-14 years). According to the Bado classification system 73 of typeⅠ( extension type) accounted for 57.0%; 20 of type Ⅱ (flexion type), 15.6%; 33 of type Ⅲ (adduction type), 25.8%; 2 of type Ⅳ, 1.6%. 50 patients received conservative treatment, all belonged to the fresh fractures (within 1 week after injury); the other 78 patients were operated, including 30 fresh fractures after failure of closed reduction and 48 old fractures. The conservative patients received manipulation and plaster immobilization. In the operative group, 45 patients (16 fresh and 29 old fractures) were fixed with single Kirschner wire after reduction of the radiohumeral joints, and the ulnas were free of fixation; 33 children (14 fresh and 19 old fractures) were fixed with double wire both for the radiohumeral joints and fractured ulnas. In the fresh Monteggia's fractures, the annular ligament was repaired simply without reconstruction, but in the old fractures, neither reparation nor reconstruction was needed. The plaster was kept for 4-6 weeks postoperatively. Results All patients were available at the final follow up with a mean of 5.6 years (range, 1-10 years). According to the Lihan Ming's scoring system for the motion function in children the conservative patients were classified as 42 excellent, 4 good, 2 fair and 2 poor, the excellent and good rate was 92%; and in the single wire group, there were 31 excellent, 5 good, 2 fair and 1 poor, the excellent and good rate was 93.3%; finally in the double wire group, 22 excellent, 7 good, 2 fair and 2 poor, the excellent and good rate was 87.9%. Conclusion The closed reduction should be selected first for the fresh Monteggia's fracture in children, the operation is only indicated for the special fresh or old fractures, in which neither the anatomic reduction was satisfactory nor the reduction can be kept without internal fixation. The operative technique, including the open reduction of the radiohumeral joint and fixation both with Kirschner wire and plaster,is reliable to improve the clinical results.