Department of Orthopedic Trauma, Tianjin Hospital, Tianjin, China.
Department of Anesthesiology, Tianjin Hospital, Tianjin, China.
Orthop Surg. 2020 Oct;12(5):1448-1455. doi: 10.1111/os.12784. Epub 2020 Aug 13.
To figure out the difference between patients with posterior Monteggia fractures which were concomitant with proximal radioulnar joint (PRUJ) dislocation and posterior fracture-dislocation of the proximal ulna that were not concomitant with PRUJ.
From January 2016 to January 2019, 37 consecutive adult patients who had posterior fracture-dislocation of proximal ulna (no PRUJ dislocation, n = 16) and posterior Monteggia fractures (PRUJ dislocation, n = 21) were included. All patients had intraoperative fluoroscopy, computed tomography (CT) scans, and standard radiography (anteroposterior view and lateral view). The mechanism of injury, the cases with open fracture, sustained multiple injuries and classification of fracture was recorded. The clinical details of the patients such as the final range of motion (ROM) and the Broberg-Morrey scores were described.
Patients with PRUJ dislocation (ten type A, five type B, and six type D) and those without concomitant PRUJ dislocation (fifteen type A and one type C) exhibited an obvious difference according to the classifications of Jupiter et al. (P = 0.010). Ninety-five percent of patients who had PRUJ dislocation were accompanied by a metaphyseal fracture, while only 50% of the patients who did not have PRUJ dislocation were accompanied by a metaphyseal fracture (P = 0.002). Meanwhile, 16 of 20 metaphyseal fractures had more than one fragment in the group of dislocations, but five of eight metaphyseal fractures were comminuted in the control group. The two groups exhibited an obvious difference (P = 0.009). The 21 patients who sustained a radioulnar dislocation had less mean arc of flexion, pronation, and Broberg-Morrey scores were significantly less than the patients of the control group (flexion: 117.38 ± 14.46 vs 127.50 ± 13.416, P = 0.035; pronation: 59.76 ± 11.88 vs 67.50 ± 6.58, P = 0.017; Broberg-Morrey: 80.48 ± 12.17 vs 88.19 ± 10.28, P = 0.040).
Patients suffering posterior Monteggia fractures had more metaphyseal fractures, more comminuted fractures of the metaphysis, and worse ultimate ulnohumeral motion than patients of posterior fracture-dislocation of proximal ulna.
探讨伴有近端尺桡关节（PRUJ）脱位的后孟氏骨折与不伴有 PRUJ 脱位的单纯尺骨近端后骨折脱位患者之间的差异。
自 2016 年 1 月至 2019 年 1 月，共纳入 37 例连续的成人尺骨近端后骨折脱位患者（无 PRUJ 脱位，n = 16）和后孟氏骨折（PRUJ 脱位，n = 21）患者。所有患者均行术中透视、计算机断层扫描（CT）和标准 X 线摄影（前后位和侧位）。记录损伤机制、开放性骨折、多发伤及骨折分型。描述患者的临床详细信息，如最终活动范围（ROM）和 Broberg-Morrey 评分。
伴有 PRUJ 脱位（10 型 A、5 型 B 和 6 型 D）和无 PRUJ 脱位（15 型 A 和 1 型 C）的患者根据 Jupiter 等的分类有明显差异（P = 0.010）。95%伴 PRUJ 脱位的患者存在干骺端骨折，而不伴 PRUJ 脱位的患者仅有 50%存在干骺端骨折（P = 0.002）。同时，脱位组 20 例干骺端骨折中有 16 例有超过 1 个骨折块，而对照组 8 例干骺端骨折中有 5 例为粉碎性骨折。两组有明显差异（P = 0.009）。21 例发生桡尺骨脱位的患者的平均屈曲、旋前弧和 Broberg-Morrey 评分明显低于对照组（屈曲：117.38 ± 14.46 与 127.50 ± 13.416，P = 0.035；旋前：59.76 ± 11.88 与 67.50 ± 6.58，P = 0.017；Broberg-Morrey：80.48 ± 12.17 与 88.19 ± 10.28，P = 0.040）。
后孟氏骨折患者较单纯尺骨近端后骨折脱位患者更易发生干骺端骨折、干骺端骨折更粉碎、最终尺桡骨运动更差。
