The Ulnar Osteotomy Surgery With The Reconstruction Of Annular Ligament For The Treatment Of Children’s Obsolete Monteggia Fracture:a Meta-analysis

Background:Monteggia fracture in children have a high incidence in limb trauma,but the diagnosis and treatment often be delayed because of various reasons,leading to obsolete Monteggia fracture ultimately.Ulnar osteotomy plus annular ligament reconstruction always be used to strengthen and stabilize the radial head in obsolete Monteggia fractures previously,finally to achieve the purpose of treating the disease.There are many problems have been found in ulnar osteotomy plus annular ligament reconstruction recently,with the improvement of operative technology and the increase of clinical data.The complicated surgical procedure and wide scope of trauma in annular ligament reconstruction,further enlarge the degree of local soft tissue injury,causing intraoperative and postoperative complications.Recently,some studies have shown that isolated(simple)ulnar osteotomy can also achieve a better effect.Although there are many articles about the analysis of postoperative efficacy with or without annular ligament reconstruction of obsolete Monteggia fracture in children,most of them are small sample study,and its effectiveness is still not sure.So an analysis of evidence-based medicine with larger sample size and higher lever is required(to get a better conclusion).Objective:A meta-analysis was used to evaluate the postoperative efficacy of two different surgical techniques(ulnar osteotomy combined or uncombined annular ligament reconstruction)for the treatment of obsolete Monteggia fractures in children.Methods:A search was performed to find literature including randomized controlled studies and retrospective clinical cohort studies published from January 1979 to October 2017 about ulnar osteotomy for the treatment of obsolete monteggia fracture in children.And then a quality evaluation of postoperative complications was made based on the meta-analysis of evidence-based medicine.The main contents include the incidence of elbow flexion dysfunction,forearm rotation dysfunction,postoperative radial head dysplasia,dislocation of the radial head and the superior rate of elbow joint function.The data extracted from the relevant articles was analyzed by the Revman5.3 statistical software provided by the Cochrane collaboration.Results:8 articles were included in this study.These studies show that were no significant statistical differences in the incidence of elbow flexion and extension dysfunction between ligament reconstruction group and non-reconstruction group(p=0.08,OR=0.08,95%CI=0.92,4.71).In terms of the incidence of forearm rotation dysfunction,the ligament reconstruction group was higher than the non-reconstruction group,and there was a significant difference between them(p=0.007,OR=2.57,95%CI=1.29,5.14).In the incidence of postoperative radial head dysplasia,there was no significant difference between two groups(p=0.06,OR=7.65,95%CI=0.92,63.84).In terms of postoperative elbow function recovery,it has been found that the non-reconstruction group was able to recover better than another.The incidence of radial head dislocation was lower than in the ligament reconstruction group than another,and there was statistical difference between the two groups(p=0.04,OR=0.50,95%CI=0.26,0.96).Conclusion:It is obvious that isolated(simple)ulnar osteotomy can achieve a better effect than combination with annular ligament reconstruction in the treatment of obsolete Monteggia fractures in children according to the existing data.And the former can significantly reduce the incidence of forearm rotation dysfunction.However,this conclusion should be supported by a large sample and multicenter randomized controlled study.