The diagnosis and treatment of a special rare type of Monteggia equivalent fractures in children

Frontiers in Pediatrics

Pediatrics

Qingda Lu¹  Qiang Jie¹  Min Li¹  Yishan Ma¹  Fei Su¹  Yating Yang¹  Shuai Yang¹  Xue Hao¹  Haoruo Jia¹  Chenxin Liu¹  Huan Wang¹  Youting Dang¹  Bing Wang¹ 

[1] Department of Pediatric Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China;Research Center for Skeletal Developmental Deformity and Injury Repair, School of Life Science and Medicine, Northwest University, Xi’an, China;Clinical Research Center for Pediatric Skeletal Deformity and Injury of Shaanxi Province, Xi’an, China;

关键词: Monteggia equivalent;    radial neck;    fixation;    children;    diagnosis and treatment;   

DOI  :  10.3389/fped.2023.1120256

 received in 2022-12-09, accepted in 2023-03-10,  发布年份 2023

来源: Frontiers

【 摘 要 】

PurposeTo explore the characteristics, mechanism, treatment, and prognosis of head–neck separation type of Monteggia equivalent fractures in children.MethodsPatients with this injury were reviewed retrospectively. The lesion was characterized by a fracture of the ulnar with radial neck fracture but without dislocation of the radial head. Our classification was based on the direction of displacement and angulation of fractures on radiographs, divided into the extension-valgus type and flexion-varus type. The fractures were treated with reduction and internal fixation, depending on the fracture type. The clinical results were evaluated by using radiology and the Mayo Elbow Performance Score (MEPS).ResultsA total of 12 patients were followed up for an average of 40.5 months. The ulnar fractures were treated with closed reduction (CR) and K-wire fixation in one patient, elastic stable intramedullary nail (ESIN) fixation in four patients, open reduction (OR) and plate fixation in five, with no fixation in two. CR with ESIN fixation was successful in 11 patients with radial neck fractures, but one underwent OR and K-wire fixation. All fractures healed on time, with fewer complications (avascular necrosis in one patient, and bulk formation of metaphysis in another). The therapeutic efficacy was evaluated by using MEPS and was found to be excellent in 10 patients, good in one, and fair in another.ConclusionsThe head–neck separation type of Monteggia equivalent fractures in children is rare. Its characteristics are different from that of Monteggia fracture. The length and anatomic structure of the ulna should be restored and stabilized first, while the radial neck fracture should be treated with CR and ESIN fixation. Satisfactory clinical results can be achieved with fewer complications.

【 授权许可】

Unknown   
© 2023 Su, Li, Ma, Yang, Hao, Jia, Dang, Lu, Liu, Yang, Wang, Wang and Jie.