Hamaker Max, Zheng Amy, Eglseder W Andrew, Pensy Raymond A
University of Maryland School of Medicine, Baltimore, MD.
Department of Orthopaedics, University of Maryland, Baltimore, MD.
J Hand Surg Am. 2018 Jan;43(1):85.e1-85.e6. doi: 10.1016/j.jhsa.2017.08.013. Epub 2017 Sep 27.
The purposes of this study were to identify the relative frequency of Monteggia fracture patterns and to investigate the required frequency of open reduction of the proximal radiocapitellar joint.
We identified 121 Monteggia fractures at a Level I trauma center from 1996 to 2015 and included 119 in this study. These fractures were identified using a database search for the appropriate International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes as well as individual surgeons' logs. Two fellowship-trained hand surgeons reviewed the identified patients' x-rays and operative notes. Each fracture was classified using Bado's original description, excluding transolecranon and Monteggia variants.
Bado I lesion represented 68% (81 of 119) of Monteggia fractures. Annular ligament incarceration preventing radial head reduction occurred in approximately 17% (14 of 81) of this Bado type. Revision fixation of the ulna was not necessary (none of 119 cases) and functional range of motion (average arc, 117°) was recovered in most patients. The reoperation rate of 20% (23 of 119) was related to the severity of the presenting injury and hardware prominence.
Most radial head dislocations associated with Monteggia fractures occur anteriorly and will reduce with anatomic plating of the ulna. In cases where the radial head fails to reduce, entrapment of the annular ligament can be expected and open reduction is required. Revision fixation of the ulna to achieve reduction of the radial head is uncommon in our experience.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
本研究的目的是确定孟氏骨折类型的相对频率，并调查桡骨头近端关节切开复位所需的频率。
我们在一家一级创伤中心识别出1996年至2015年期间的121例孟氏骨折，本研究纳入了其中119例。这些骨折通过数据库搜索适当的国际疾病分类第九版和当前手术操作术语代码以及个别外科医生的日志来识别。两位接受过 fellowship 培训的手外科医生对识别出的患者的X线片和手术记录进行了回顾。每例骨折均根据巴多的原始描述进行分类，不包括经鹰嘴骨折和孟氏变异型。
巴多I型损伤占孟氏骨折的68%（119例中的81例）。在该巴多型骨折中，约17%（81例中的14例）出现环状韧带嵌顿导致桡骨头无法复位。尺骨无需翻修固定（119例中无1例），大多数患者恢复了功能活动范围（平均弧度，117°）。20%（119例中的23例）的再次手术率与受伤时的严重程度和内固定物突出有关。
与孟氏骨折相关的大多数桡骨头脱位发生在前侧，通过尺骨解剖钢板固定可实现复位。在桡骨头无法复位的情况下，可预期环状韧带嵌顿，需要切开复位。根据我们的经验，通过翻修尺骨固定来实现桡骨头复位并不常见。
研究类型/证据水平：预后性IV级。
