Bado Ⅲ型孟氏骨折具有较高的损伤和治疗相关并发症发生率：单中心 73 例骨折研究。

Bado type III Monteggia fractures have a high injury- and treatment-related complication rate: a single center study of 73 fractures.

机构信息

Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.

Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki; Department of Pediatric Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.

出版信息

Acta Orthop. 2024 Oct 14;95:600-606. doi: 10.2340/17453674.2024.42111.

DOI:10.2340/17453674.2024.42111

PMID:39404257

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11474005/

Abstract

BACKGROUND AND PURPOSE

Monteggia fractures can be problematic injuries. The aim of this population-based study is to evaluate the risk of complications according to the Bado types, clinical outcome, and incidence.

METHODS

72 children (median age 6, range 2-11 years) with 73 Monteggia fractures treated during 2014-2022 were identified from the institutional fracture register. Timing of diagnosis, complications, and method of treatment were registered. Outcomes were assessed at mean 4 years (1-9) follow-up in 68 (94%) children. The census population (< 16 years old) in Helsinki metropolitan area during the study period was assessed.

RESULTS

Bado types I (n = 43) and III (n = 27) comprised all but 3 of the fractures. Diagnosis was made on admission in 57, and with a 1-8-day delay in 16 children. 8 children had sustained an associated nerve injury. 35 children were treated operatively, 7 after failed closed treatment. 4 reoperations were performed, including 3 ulnar osteotomies. The risk of complications (odds ratio [OR] 4.9, 95% confidence interval [CI] 1.7-14) and closed treatment failures (OR 12.3, CI 1.3-118) was higher in Bado type III than in type I injuries. 60 children attended for clinical follow-up, all had congruent radio-humeral joints and full range of elbow and forearm motion. Mean PedsQL was 94 (72-100) and QuickDash 3 (0-13). 8 additional children reported normal elbow functions by phone. The calculated mean annual incidence of Monteggia injuries was 2.9/100,000 children.

CONCLUSION

Monteggia fractures are rare (2.9/100,000 yearly). Bado type III injuries are associated with a high risk of complications.

摘要

背景与目的

孟氏骨折是一种复杂的损伤。本研究旨在基于人群评估根据 Bado 分型、临床结果和发生率的并发症风险。

方法

从机构骨折登记处确定了 2014 年至 2022 年间治疗的 72 名儿童（中位数年龄 6 岁，范围 2-11 岁），共有 73 例孟氏骨折。记录诊断时间、并发症和治疗方法。68 例（94%）儿童在平均 4 年（1-9 年）随访时进行了评估。评估了研究期间赫尔辛基大都市区的人口普查（<16 岁）。

结果

Bado Ⅰ型（n=43）和Ⅲ型（n=27）除 3 例外均包括所有骨折。57 例患儿在入院时即确诊，16 例患儿延迟 1-8 天确诊。8 例患儿合并神经损伤。35 例患儿接受了手术治疗，7 例患儿在闭合治疗失败后接受了手术治疗。4 例患儿进行了再次手术，包括 3 例尺骨切开术。Bado Ⅲ型骨折的并发症风险（比值比[OR]4.9，95%置信区间[CI]1.7-14）和闭合治疗失败风险（OR 12.3，CI 1.3-118）均高于 Bado Ⅰ型骨折。60 名患儿接受了临床随访，所有患儿均有一致的肱桡关节和完整的肘部和前臂活动范围。平均 PedsQL 为 94（72-100），QuickDash 3 为 0-13。另外 8 名患儿通过电话报告了正常的肘部功能。计算得出孟氏骨折的年平均发生率为 2.9/10 万儿童。