Singh Ajay-Pal, Dhammi Ish-Kumar, Jain Anil-Kumar, Raman Rajeev, Modi Prashant
Punjab Civil Medical Services-I, Mukerian, Punjab, India.
Chin J Traumatol. 2011;14(4):221-6.
Monteggia fracture dislocation equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a review of the literature.
A retrospective record of Monteggia fracture dislocation (2003-2008) was reviewed from medical record department of our institute. Classic Monteggia fracture dislocation, children below 12 years or adults over 50 years, as well as open grade II and III cases were excluded from this study. Monteggia variant inclusion criteria included fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 females with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients.
Follow-up ranged from 1-4 years, mean 2.6 years. Patients were assessed clinicoradiologically. Mayo Elbow Performance Score was employed to assess the outcomes. At final follow-up, the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20 degree 116 degree, 50 degree and 55 degree for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures.
Monteggia fracture dislocation equivalents are rare injuries and pre-surgery recognition by radiographs and 3-D CT helps make optimal plan. The poor results usually relate to intraarticular damage, coronoid fractures and comminution of the ulna and radial head fractures.
孟氏骨折脱位等效损伤，尽管巴多已对此进行过描述，但仍是一种未分类的实体。我们旨在回顾性分析18例孟氏骨折变异病例，并结合文献复习讨论其损伤机制、治疗方法及预后。
从我院病案室回顾性记录2003年至2008年的孟氏骨折脱位病例。本研究排除经典孟氏骨折脱位、12岁以下儿童或50岁以上成人病例，以及开放性Ⅱ级和Ⅲ级病例。孟氏骨折变异病例纳入标准包括尺骨近端骨折合并桡骨头或颈骨折以及骨骼成熟。共确定26例孟氏骨折变异病例，18例可供随访，其中男性11例，女性7例，平均年龄35岁。尺骨骨折采用加压钢板联合张力带钢丝固定治疗。12例患者进行了桡骨头/颈重建，6例患者进行了切除。
随访时间为1至4年，平均2.6年。对患者进行临床和影像学评估。采用梅奥肘关节功能评分评估预后。末次随访时，10例患者结果为优，4例为良，2例为可，2例为差。肘关节平均活动范围为：伸展20度、屈曲116度、旋前50度、旋后55度。2例患者出现异位骨化和肘关节僵硬并发症。1例尺骨不愈合患者，最初采用张力带钢丝固定治疗，后采用锁定重建钢板重新固定并植骨处理。仅该患者因不愈合需要植骨。另1例患者应其要求取出了植入物。我们系列研究的结果与关节内损伤程度、冠状突骨折和粉碎性骨折密切相关。
孟氏骨折脱位等效损伤是罕见损伤，术前通过X线片和三维CT识别有助于制定最佳治疗方案。预后不佳通常与关节内损伤、冠状突骨折以及尺骨和桡骨头骨折的粉碎有关。
