Hart Christopher M, Alswang Jared, Bram Joshua, Kim Samuel T, Arkader Alexandre, Silva Mauricio
UCLA Orthopaedic Hospital Department of Orthopaedics, David Geffen School of Medicine, University of California, Los Angeles.
Orthopaedic Institute for Children, Los Angeles, CA.
J Pediatr Orthop. 2021 Aug 1;41(7):412-416. doi: 10.1097/BPO.0000000000001868.
The treatment of acute pediatric Monteggia injuries involving a complete fracture of the ulna remains controversial. The purpose of this study is to compare the outcomes of immediate operative fixation to a trial of closed reduction and casting of acute pediatric Monteggia fractures involving complete ulna fractures.
We performed a retrospective analysis of 73 patients with Monteggia injuries with complete ulna fractures presenting to 2 pediatric trauma centers from 2008 to 2018. Patients were divided in 2 groups based on the treatment received: patients in group 1 (n=37, 51%) received surgical treatment; patients in group 2 (n=36, 49%) received a trial of closed reduction and casting. The mean follow-up of 15.2 weeks (range, 4.1 to 159 wk). The incidence of radiocapitellar joint redislocation, need for further intervention, complications, and recovery of range of motion was compared between the groups.
There were no significant differences between groups 1 and 2 with regards to age (6 vs. 5.8 y, P=0.69), sex (54% vs. 47% female, P=0.64), or the mean maximal ulnar angulation (23 vs. 19 degrees, P=0.94). There was a higher proportion of proximal ulna fractures in group 1 versus 2 (62% vs. 33%, respectively, P=0.02). Bado type III and IV fractures were associated with operative management [odds ratio=22 (95% confidence interval: 1.68-288.7) and 14.9 (95% confidence interval: 2.09-106), respectively]. In group 2, 5 patients (13.9%) sustained a loss of radiocapitellar joint reduction following closed reduction and casting and ultimately received operative treatment. At final follow-up, there were no cases of recurrent radiocapitellar dislocation in either group, all patients achieved fracture union and regained full elbow range of motion.
Even in the presence of a complete ulna fracture, a trial of nonoperative management of acute pediatric Monteggia fractures with closed reduction and casting can result in comparable outcomes to those obtained with immediate surgical management. The nonoperative management of Monteggia fractures requires close clinical follow-up to ensure no loss of reduction.
Level IV-therapeutic studies, case series.
小儿急性孟氏骨折合并尺骨完全骨折的治疗仍存在争议。本研究的目的是比较急性小儿孟氏骨折合并尺骨完全骨折时，立即手术固定与闭合复位加石膏固定的疗效。
我们对2008年至2018年在2个小儿创伤中心就诊的73例孟氏骨折合并尺骨完全骨折的患者进行了回顾性分析。根据接受的治疗方法将患者分为2组：第1组（n = 37，51%）接受手术治疗；第2组（n = 36，49%）接受闭合复位加石膏固定治疗。平均随访15.2周（范围4.1至159周）。比较两组之间桡骨头关节再脱位的发生率、进一步干预的必要性、并发症以及活动范围的恢复情况。
第1组和第2组在年龄（6岁对5.8岁，P = 0.69）、性别（女性分别为54%对47%，P = 0.64）或平均最大尺骨成角（23度对19度，P = 0.94）方面无显著差异。第1组近端尺骨骨折的比例高于第2组（分别为62%对33%，P = 0.02）。Bado III型和IV型骨折与手术治疗相关[比值比分别为22（95%置信区间：1.68 - 288.7）和14.9（95%置信区间：2.09 - 106）]。在第2组中，5例患者（13.9%）在闭合复位加石膏固定后出现桡骨头关节复位丢失，最终接受了手术治疗。在末次随访时，两组均无桡骨头反复脱位的病例，所有患者骨折均愈合，肘关节活动范围完全恢复。
即使存在尺骨完全骨折，小儿急性孟氏骨折采用闭合复位加石膏固定的非手术治疗试验也能产生与立即手术治疗相当的疗效。孟氏骨折的非手术治疗需要密切的临床随访，以确保复位不丢失。
IV级 - 治疗性研究，病例系列。
Zotero 插件