The relationship between the classification of the Monteggia dislocation-fracture in adult and its prognosis / 中华骨科杂志

ABSTRACT

Objective To study the relationship between the Bado's classification of the Monteggia fracture in adult and their prognosis. Methods Studying the 60 patients in our hospital suffering from Monteggia fracture-dislocation during 10 years between 1994 to 2004, and their clinical data of the follow-up is analysised with statistics. There were 26 cases with Bado type Ⅰ fracture-dislocations, 14 cases with Bado type Ⅱ fracture-dislocations, 19 cases with Bado type Ⅲ and 1 case with Bado type Ⅳ fracture-dislocations. The fractures of the shaft of the ulna were treated operatively with open reduction and internal fixation using plates and screws. The fractures of the radial head were operated with open reduction and internal fixation, or are treated with the resection of the partial or total radial head. For the cases of the dislocation of the radial head without fracture, the most commonly used treatment method was to reduce the dislocation closely and stable the position with external fixation by a plaster cast. For the injury of the radial nerve associated with the Monteggia fracture dislocation, no operation had been done to make an exploration. Rank Sun Test of NoSA system was adopted to analysis the clinical data gained above. Results The average duration of the follow-up was 24 months (12-72 months). The results were graded according to the score system of Broberg and Morrey. In Bado type Ⅰ, 24 cases were considered satisfactory and 2 cases unsatisfactory, satisfactory ratio is 92%; In Bado type Ⅱ, 10 cases satisfactory and 4 cases unsatisfactory, satisfactory ratio was 71%; In Bado type Ⅲ and type Ⅳ, all the cases gained satisfactory results, satisfactory ratio was 100%. Rank Sun Test showed there was no obvious difference on prognosis between every group of the Bado's classification system. But statistical obvious difference could be found between the group with the fractures of the radial head and the group without. Conclusion The classification system of Bado has no prediction prognosis. In adult Monteggia fracture, the final result largely depends on whether there is a fracture of the radial head.