Lu Xuemin, Kun Wang Yu, Zhang Jianli, Zhu Zhenhua, Guo Yuan, Lu Ming
Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China.
J Pediatr Orthop. 2013 Jun;33(4):398-402. doi: 10.1097/BPO.0b013e3182812762.
Open reduction of the radial head is usually necessary in the treatment of a missed Monteggia fracture. However, the best way to stabilize the reduction remains controversial. The purpose of this study is to present our experience using the dual-socket external fixator to stabilize the ulna osteotomy and capture the reduction of the radial head.
We reviewed 33 patients with missed Monteggia fracture who underwent open reduction, ulnar osteotomy, and dual-socket external fixation from 2004 to 2010. The average age of this group was 7 years and the average time to surgical treatment after the fracture was 15 months. We treated all patients with open reduction of the radial head, fully releasing the capsular contracture, removing the fibrous scar tissue within the joint, performing ulnar osteotomy, and fixing the osteotomy with dual-socket external fixation. The clinical and radiographic follow-up averaged 38 months. Descriptive statistics utilized the Student test to compare the preoperative and postoperative functional movement of elbow and forearm.
All patients had excellent clinical and radiographic outcomes without losing motion of the elbow and forearm, and all patients maintained reduction of the radial head at the final follow-up. There were no significant differences in the motion of the elbow and forearm between preoperative and postoperative examinations. Delayed union of the ulna occurred in 2 cases, both successfully treated with autologous iliac crest bone graft at 7 months after the operation. Three cases had early redislocation of the radial head, and these were treated successfully by changing the position of the ulnar osteotomy and readjusting the external fixators.
Dual-socket external fixation has the major advantage of permitting and capturing the optimal position of the ulna osteotomy to achieve the best possible reduction of the radial head. A further advantage is the possibility of easily changing the position of the ulnar osteotomy by adjustment of the fixator should the radial head subluxate or redislocate in the early postoperative period as had occurred in 3 of our cases. We conclude that our procedure of fully releasing the capsular contractures, removing scar tissue, ulnar osteotomy, reduction of the radial head, and fixation of the osteotomy with dual-socket external fixation is a safe and effective way to manage children with a missed Monteggia fracture.
Therapeutic level IV.
在治疗漏诊的孟氏骨折时，通常需要对桡骨头进行切开复位。然而，维持复位的最佳方法仍存在争议。本研究的目的是介绍我们使用双槽外固定器稳定尺骨截骨并维持桡骨头复位的经验。
我们回顾了2004年至2010年间接受切开复位、尺骨截骨和双槽外固定治疗的33例漏诊孟氏骨折患者。该组患者的平均年龄为7岁，骨折后至手术治疗的平均时间为15个月。我们对所有患者均进行了桡骨头切开复位，充分松解关节囊挛缩，清除关节内纤维瘢痕组织，进行尺骨截骨，并用双槽外固定器固定截骨部位。临床和影像学随访平均为38个月。描述性统计采用学生检验比较术前和术后肘关节及前臂的功能活动。
所有患者均获得了良好的临床和影像学结果，肘关节和前臂活动未丧失，所有患者在末次随访时桡骨头均维持复位。术前和术后检查时肘关节和前臂的活动度无显著差异。2例发生尺骨延迟愈合，均在术后7个月成功采用自体髂骨植骨治疗。3例出现桡骨头早期再脱位，通过改变尺骨截骨位置并重新调整外固定器成功治疗。
双槽外固定的主要优点是允许并维持尺骨截骨的最佳位置，以实现桡骨头的最佳复位。另一个优点是，如果术后早期出现桡骨头半脱位或再脱位（如我们的3例患者），可通过调整固定器轻松改变尺骨截骨的位置。我们得出结论，我们充分松解关节囊挛缩、清除瘢痕组织、尺骨截骨、桡骨头复位并用双槽外固定器固定截骨部位的手术方法是治疗儿童漏诊孟氏骨折的一种安全有效的方法。
治疗性IV级。
