The Study On Clinical Results In Children's Monteggia Fracture With Different Methods

Objective: To analysis the clinical outcome after different treatment methods for the Monteggia's fracture in children.To inquire into the indications of conservative treatment, open reduction and internal fixation while annular ligament repaired or annular ligament reconstruction. And to evaluate the factors affecting prognosis of Monteggia fracture.Materials and Methods:A retrospective study for 83 patients of Monteggia's fractures in children. Who were hospitalized in our hospital from June 2002 to September 2009,carried out the surgical treatments.45 cases of them were treated conservatively and were considered of successful cases; fresh fractures failed in conservative treatment underwent operation for ulnar fracture reduction and fixation, or annular ligament and joint capsule repaired, 22 cases; annular ligament can not be successfully repaired in acute fractures , 11cases, delayed fracture , 5cases,a total of 16 cases,underwent annular ligament reconstruction with the deep forearm fascia.We measured the injured elbow flexion and extension/ rotation range, and measured the activities of the contralateral normal elbow flexion and extension / rotation range during follow-up .Calculated the motion score and elbow function score (JOA)of each patient, different groups were compared. According to Li Hanmin' elbow function grading standards, assess the elbow function.Results:All patients were followed-up for 6 months to 7 years 9 months (average 2.9 years). According to Li Hanmin's elbow function classification , the conservative treatment group were classificed as excellent in 41 patients, good in 3, fair in one case, and no poor case , the excellent and good rate of 98%, the elbow rotation range is larger than open reduction and annular ligament repaired group ( P <0.05), significantly better than the annular ligament reconstruction group (P <0.01); open reduction and annular ligament repaired group, excellent in 15 cases, good in 4 cases, fair in 3 cases, no poor, excellent and good rate of 86%, the elbow function is better than the annular ligament reconstruction group (P <0.05); annular ligament reconstruction group, excellent in 8 cases, good in 4 cases, fair in 3 cases and poor in 1 case,excellent and good rate of 75%. Postoperative elbow functions were improved (P <0.05) than preoperative in delayed Fractures. 17 of 18 cases of nerve injury were relieved nerve exploration, observated by 1 month to six months, returned to normal.Conclusions:The Monteggia's fracture in children should be treated based on the radius and ulna bone fractures and the annular ligament damaged, with "individual" treatment. The outcome of the conservative treatment is better than open reduction, and even more than those who undergo annular ligament reconstruction. The ulnar fracture and radial head dislocation should be anatomical reduced. And the ulnar should be concerned about deformity and radial head about subluxation or dislocation during follow-up. Annular ligament can not be repaired in fresh fracture cases,or delayed fractures, well fixed the ulnar fracture, replace the annular ligament with a forearm deep fascia , can still expect good results.