Department of Orthopaedic Surgery.
Department of Orthopaedic Surgery, Shandong Provincial Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
J Pediatr Orthop. 2023 Oct 1;43(9):e719-e725. doi: 10.1097/BPO.0000000000002486. Epub 2023 Aug 11.
Magnetic resonance imaging (MRI) is commonly performed in children with elbow injuries to visualize soft tissues such as the annular ligament. Herein, we investigated the MRI manifestations of annular ligament injuries in children with Monteggia fractures following attempted closed reduction.
The clinical and imaging data of 88 children with acute Monteggia fractures treated at our hospital between 2015 and 2019 were analyzed. Clinically and radiographically, 67 patients achieved radiologic reduction of the radial head at the time of MRI, whereas 21 patients had a failed closed reduction. Annular ligament injury and superior radioulnar joint congruency were analyzed qualitatively, and the maximum superior radioulnar joint gap distance was measured.
MRI manifestations of annular ligament injury were primarily characterized as varying degrees of annular ligament displacement, as follows: I degree (10 patients), the annular ligament encircled the radial head without displacement; II degree (5 patients), the annular ligament was partially displaced but visibly encircled the radial head at the level of the radial notch; and III degree (73 patients), the annular ligament was completely displaced. In 15 patients with I and II degrees annular ligament injuries, the annular ligament encircled the radial head (maximum superior radioulnar joint gap distance, 1.2±0.3 mm), showing good congruency of the superior radioulnar joint. In 73 patients with III degree annular ligament injury, the annular ligament was displaced and did not encircle the radial head (maximum superior radioulnar joint gap distance, 3.3±2.7 mm; P <0.05), showing good congruency of the superior radioulnar joint in 25 of 73 patients, and significantly poor congruency in 48 of 73 patients ( P <0.05).
Annular ligament injuries in children with Monteggia fractures exhibit different degrees of displacement of the annular ligament. In I and II degree annular ligament injuries, the annular ligament still encircles the radial head. In III degree annular ligament injuries, the annular ligament is displaced away and is no longer around the radial head. Without the annular ligament restraining the radial head, the superior radioulnar joint is more likely to exhibit poor congruency and increased gap distance.
Level II.
磁共振成像（MRI）常用于检查肘部受伤的儿童，以观察环状韧带等软组织。在此，我们研究了试图闭合复位后儿童孟氏骨折的 MRI 表现。
分析了 2015 年至 2019 年我院收治的 88 例急性孟氏骨折患儿的临床和影像学资料。临床和影像学上，67 例患儿在 MRI 时发现桡骨头达到放射学复位，而 21 例患儿闭合复位失败。定性分析环状韧带损伤和上尺桡关节吻合度，测量最大上尺桡关节间隙距离。
环状韧带损伤的 MRI 表现主要为环状韧带不同程度的移位：Ⅰ度（10 例），环状韧带环绕桡骨头无移位；Ⅱ度（5 例），环状韧带部分移位，但在桡切迹水平仍可见环绕桡骨头；Ⅲ度（73 例），环状韧带完全移位。在 15 例Ⅰ度和Ⅱ度环状韧带损伤患者中，环状韧带环绕桡骨头（最大上尺桡关节间隙距离，1.2±0.3mm），上尺桡关节吻合度良好。在 73 例Ⅲ度环状韧带损伤患者中，环状韧带移位，不环绕桡骨头（最大上尺桡关节间隙距离，3.3±2.7mm；P<0.05），25 例上尺桡关节吻合度良好，48 例上尺桡关节吻合度明显不良（P<0.05）。
孟氏骨折患儿的环状韧带损伤有不同程度的环状韧带移位。在Ⅰ度和Ⅱ度环状韧带损伤中，环状韧带仍环绕桡骨头。在Ⅲ度环状韧带损伤中，环状韧带被移位，不再环绕桡骨头。由于没有环状韧带限制桡骨头，上尺桡关节更容易出现吻合不良和间隙增大。
Ⅱ级。
