Zivanovic Dragoljub, Marjanovic Zoran, Bojovic Nikola, Djordjevic Ivona, Zecevic Maja, Budic Ivana
Faculty of Medicine, University of Nis, 18000 Nis, Serbia.
Clinic for Pediatric Surgery, Pediatric Orthopedics and Traumatology, University Clinical Centre Nis, 18000 Nis, Serbia.
Children (Basel). 2022 Jul 22;9(8):1100. doi: 10.3390/children9081100.
(1) Background: A Monteggia fracture is an infrequent injury in children. It can be missed during an initial consultation in 20-50% of patients. Chronic radial head dislocation may lead to several complications. Thus, surgical reconstruction of chronic Monteggia injuries is justified. The aim of this study is to analyze the single tertiary center experience in the treatment of neglected Monteggia fractures. (2) Methods: A retrospective study of patients treated for missed Monteggia fractures was conducted. Hospital records, operative charts, follow-up records and a set of X-rays were analyzed for each patient. Radiographic results were graded as good, moderate or poor. The functional status of elbows was estimated using the Mayo Elbow Performance Index. (3) Results: A total of 13 patients (8 boys and 5 girls) aged 4-12 years (mean 7.15) were treated during the study period. An angulation osteotomy of the ulna was performed in ten patients and a radial shortening osteotomy in three patients. A Bell-Tawse annular ligament reconstruction was performed in five patients, and a direct repair was performed in two patients. Eight patients had radiocapitellar trans-fixation. There were nine good radiographic results, three moderate and one poor. The functional result was excellent in nine patients, good in three and poor in one. (4) Conclusions: Our work has many limitations (only 13 patients and different types of operations), and conclusions should be drawn very carefully from such a small and diverse group. The surgical reconstruction of neglected Monteggia fractures in children should be attempted in all patients. Angulation and elongation osteotomies of the ulna are suitable for most patients. If there is a marked overgrowth of the radius, gradual ulnar lengthening and radial head reduction using the Ilizarov method may be a better option. Annular ligament reconstruction is not mandatory.
(1) 背景：孟氏骨折在儿童中是一种少见的损伤。在初次会诊时，20% - 50%的患者可能会被漏诊。桡骨头慢性脱位可能导致多种并发症。因此，对慢性孟氏损伤进行手术重建是合理的。本研究的目的是分析单一三级中心治疗被忽视的孟氏骨折的经验。(2) 方法：对治疗漏诊孟氏骨折的患者进行回顾性研究。分析每位患者的医院记录、手术记录、随访记录和一组X线片。根据影像学结果分为优、中、差三个等级。使用梅奥肘关节功能指数评估肘关节的功能状态。(3) 结果：在研究期间共治疗了13例患者（8例男孩和5例女孩），年龄4 - 12岁（平均7.15岁）。10例患者进行了尺骨成角截骨术，3例患者进行了桡骨缩短截骨术。5例患者进行了贝尔 - 陶斯环形韧带重建术，2例患者进行了直接修复。8例患者进行了桡骨头穿针固定。影像学结果为优的有9例，为中的有3例，为差的有1例。功能结果为优的有9例，为好的有3例，为差的有1例。(4) 结论：我们的研究有很多局限性（仅13例患者且手术方式多样），从这样一个小且多样的群体中得出结论应非常谨慎。对于所有儿童被忽视的孟氏骨折患者都应尝试进行手术重建。尺骨的成角和延长截骨术适用于大多数患者。如果桡骨有明显过度生长，使用伊里扎洛夫方法进行逐渐尺骨延长和桡骨头复位可能是更好的选择。环形韧带重建并非必需。
