Department of Orthopaedics, Semmelweis University, Üllői út 78/B, Budapest 1082, Hungary.
Department of Péterfy Hospital and Jenő Manninger National Institute for Traumatology, Fiumei út 17., Budapest 1081, Hungary.
Injury. 2021 Mar;52 Suppl 1:S57-S62. doi: 10.1016/j.injury.2020.02.033. Epub 2020 Feb 16.
The literature places the occurrence of paediatric Monteggia lesions between 1.5% and 3% of all childhood elbow injuries. There are circumstances, which may make early correct diagnosis difficult. Failure to make an early correct diagnosis may have catastrophic consequences on joint range of motion in the chronic stage. The goal of this paper is to describe our three-step approach to the treatment of acute Monteggia lesions based on the stability and radiological appearance of the fracture dislocation, to give an overview of possible pitfalls and clinical and radiological signs that aid the diagnostic process.
Retrospective analysis of 23 patients treated for this type of injury at our Department over a period of 6 years was performed. Treatment options were 1. Closed reduction under image intensifier followed by immobilization in over the elbow cast, 2. Open reduction and intramedullary nailing with ESIN, or 3. Open reduction and plate osteosynthesis. Average follow-up was 37 months. In our Department we aim for definitive treatment of fracture-dislocations in children within the acute setting. In the 23 acute cases, the selected procedure-reduction+casting/reduction+ESIN/reduction+plating - was performed within 2 to 16 h of arrival. 10 patients were treated with reduction+casting, 10 with reduction+ESIN and 3 with reduction+plating.
21 patients were available for long-term follow-up. No nerve or tendon injuries or infections were observed in these cases. By managing the patients with the Three Step Method retaining the reduction was successful in all but one of our acute cases in the study period. Excellent range of motion was observed in all three groups.
The Three Step Method allows for primary definitive treatment of these lesions with low complication rates and good range of motion result. Implementing the three step method in the acute phase helps avoid catastrophic consequences on joint range of motion in the chronic stage.
小儿孟氏骨折约占儿童肘部损伤的 1.5%至 3%。但有些情况下，早期正确诊断可能较为困难。如果早期未能做出正确诊断，在慢性期可能会对关节活动范围产生灾难性后果。本文旨在描述我们基于骨折脱位稳定性和影像学表现的三步法治疗急性孟氏骨折的方法，概述有助于诊断过程的可能陷阱和临床及影像学特征。
对我院 6 年来收治的 23 例此类损伤患者进行回顾性分析。治疗方案包括：1. 在影像增强器下闭合复位，然后用肘上石膏固定；2. 采用 ESIN 进行切开复位内固定；3. 切开复位钢板内固定。平均随访 37 个月。我们科室的目标是在急性阶段对儿童骨折脱位进行确定性治疗。在 23 例急性病例中，在受伤后 2 至 16 小时内选择进行复位+石膏固定/复位+ESIN/复位+钢板内固定。10 例患者接受复位+石膏固定治疗，10 例接受复位+ESIN 治疗，3 例接受复位+钢板内固定治疗。
21 例患者获得长期随访。在这些病例中，未观察到神经或肌腱损伤或感染。通过采用三步法对患者进行治疗，在研究期间，除了 1 例急性病例外，其余病例均保留了复位。在所有 3 组中，均观察到了良好的关节活动范围。
三步法可对这些损伤进行初级确定性治疗，并发症发生率低，关节活动范围恢复良好。在急性阶段实施三步法有助于避免慢性期对关节活动范围产生灾难性后果。
