Department of Orthopedics, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
Department of Orthopedics, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, Hunan, People's Republic of China.
Sci Rep. 2022 Oct 7;12(1):16819. doi: 10.1038/s41598-022-21019-4.
Missed Monteggia fractures in children may cause pain, deformity, decreased range of motion, neurological symptoms, and late arthritis of the elbow. Numerous surgical techniques have been advocated to reconstruct missed Monteggia lesions. The purpose of the present study were first to evaluate the clinical and radiographic outcomes after open reduction of the radial head and corrective osteotomy of the ulna, second to identify the factors associated with the preoperative radial notch/head appearance and the postoperative radiographic results. This study investigated the preoperative MRI presentation and the treatment of 29 patients who were diagnosed missed Monteggia fracture. Radiologic and clinical results of these patients were evaluated retrospectively, and the patient's and surgical factors related to preoperative radial notch/head appearance and the postoperative radiographic results were analyzed. Of the 29 patients, the average Kim elbow performance score at the last follow-up was 93.6, with 25 excellent, three good, one fair, and no poor results. 19 children had reduced radial heads, 8 had a subluxated radial head and 2 had dislocated radial heads at the last follow-up. The patient's gender and age had no significant influence on the appearance of radial notch/head and final radiographic results. However, the appearance of radial notch/head can significantly affect the final radiographic result (P < 0.001). The interval time was an important factor which related with the appearance of radial notch/head and final radiographic results (P < 0.001). Treating a missed Monteggia fracture by open reduction of the radial head and corrective osteotomy of the ulna is generally successful and preoperative MRI is meaningful for evaluation of the condition of the radial head and the radial notch which is related with the final radiographic result. The interval time from injury to operation exceeds 6 months, the risk of radial notch/head abnormality and radial head subluxation/re-dislocation after operation significantly increase.
儿童孟氏骨折漏诊可能导致疼痛、畸形、活动范围减小、神经症状和肘部晚期关节炎。已经提出了许多手术技术来重建漏诊的孟氏损伤。本研究的目的首先是评估切开复位桡骨头和尺骨矫正截骨术后的临床和影像学结果，其次是确定与术前桡骨头切迹/头外观和术后影像学结果相关的因素。本研究调查了 29 例漏诊孟氏骨折患者的术前 MRI 表现和治疗方法。回顾性评估这些患者的放射学和临床结果，并分析与术前桡骨头切迹/头外观和术后影像学结果相关的患者和手术因素。在 29 例患者中，末次随访时 Kim 肘部功能评分平均为 93.6 分，其中 25 例为优，3 例为良，1 例为可，无差。19 例患儿桡骨头变小，8 例桡骨头半脱位，2 例桡骨头脱位。患者性别和年龄对桡骨头切迹/头的外观和最终影像学结果无显著影响。然而，桡骨头切迹/头的外观明显影响最终影像学结果（P<0.001）。间隔时间是与桡骨头切迹/头外观和最终影像学结果相关的重要因素（P<0.001）。切开复位桡骨头和尺骨矫正截骨术治疗漏诊孟氏骨折通常是成功的，术前 MRI 对评估桡骨头和桡骨头切迹的状况有意义，这与最终的影像学结果有关。受伤至手术的间隔时间超过 6 个月，术后桡骨头切迹/头异常和桡骨头半脱位/再脱位的风险显著增加。
