Koc University Hospital, Orthopaedics and Traumatology Department, Istanbul-Türkiye.
Koc University School of Medicine, Orthopaedics and Traumatology Department, Istanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2023 Jun;29(6):724-732. doi: 10.14744/tjtes.2022.52042.
This study aims to describe the functional outcome of true and equivalent Monteggia fracture-dislocations in the pediatric population. We also provided a review of the literature about the treatment options.
Five surgically and three conservatively treated patients were identified who were treated in 2009-2021. The study pop-ulation consisted of six female and two male patients. The mean age at the time of treatment was 7. The mean follow-up time was 55 months (range, 12-128). The Mayo Elbow Performance Score and the Oxford Elbow Score were used for outcome evaluation. Range of motion and grip strengths were also evaluated.
There were two Bado type 1 and six Monteggia equivalent injuries. Closed reduction and casting were utilized for the two Bado type 1 injuries as the initial treatment. However, one had a radial head re-dislocation and had to be treated operatively. This patient had a radial head re-dislocation after the surgery and was followed up conservatively. Three Monteggia equivalent injuries were treated with closed reduction and casting, with no complications. One patient had a radial head anterior dislocation with plastic deformation of the ulna, and this patient was managed with CORA-based corrective ulnar osteotomy. For Monteggia injuries, the main treatment objective is to restore the ulnar length. Bilateral computed tomography imaging with 3D reconstruction can be utilized in preoperative planning of Monteggia fracture-dislocations to customize the treatment. Close observation is essential to detect radial head subluxation, which needs early intervention before irreversible changes occur.
The true/equivalent Monteggia fractures' main treatment goal is to restore the ulnar length. Conservative treatment, with a close follow-up, is the first option if closed reduction can be achieved. If closed reduction is not possible, careful preop-erative planning and early rehabilitation are key to success for management of Monteggia fractures.
本研究旨在描述儿童真性和假性孟氏骨折脱位的功能结果，并对治疗选择进行文献回顾。
2009 年至 2021 年期间，共发现 5 例手术治疗和 3 例保守治疗的患者。研究人群包括 6 名女性和 2 名男性，治疗时的平均年龄为 7 岁。平均随访时间为 55 个月（范围 12-128 个月）。采用 Mayo 肘关节功能评分和牛津肘关节评分进行疗效评估，同时评估关节活动度和握力。
有 2 例 Bado 1 型和 6 例孟氏等效损伤。2 例 Bado 1 型损伤采用闭合复位和石膏固定作为初始治疗，但其中 1 例出现桡骨头再脱位，需要手术治疗。该患者术后出现桡骨头再脱位，行保守治疗。3 例孟氏等效损伤采用闭合复位和石膏固定治疗，无并发症。1 例患者出现桡骨头前脱位伴尺骨塑性变形，采用 CORA 矫正尺骨截骨术治疗。孟氏骨折脱位的主要治疗目标是恢复尺骨长度。术前可采用双侧 CT 成像和 3D 重建，有助于制定治疗方案。需要密切观察以发现桡骨头半脱位，在发生不可逆转改变之前需要早期干预。
真性/假性孟氏骨折的主要治疗目标是恢复尺骨长度。如果可以实现闭合复位，保守治疗和密切随访是首选。如果无法闭合复位，则需要仔细的术前规划和早期康复，这是成功治疗孟氏骨折的关键。
