| Objective:Missed Monteggia fracture comes from missed and misdiagnosed Monteggia fracture.Monteggia fracture accounts for 1% of forearm fracture.Dislocation /subluxation of radial head associated with ulnar fracture is easy to be ignored.The missed diagnosis rates of emergency doctors and radiologists are as high as 50% and25% respectively.Clinically,Missed Monteggia fractures are mostly treated by surgery.If not handled properly,it may lead to a series of long-term complications such as elbow deformity,nerve paralysis,dysfunction,pain,fatigue and even osteoarthritis.In the treatment of Missed Monteggia fractures in children,on the basis of ulnar osteotomy and annular ligament reconstruction,another percutaneous Kirschner wire fixation of the humeral radial joint has been widely used,because it can maintain the stability of the humeral radial joint to a certain extent in the early postoperative period.The purpose of this study was to analyze the efficacy and prognosis of intraoperative percutaneous K-wire fixation of humeroradial joint in the surgical treatment of missed Monteggia fractures in children.Methods:The data of 68 eligible children with Missed Monteggia fracture treated in our hospital from January 2015 to December 2020 were collected and sorted out.The children were divided into two groups according to whether to use percutaneous Kirschner wire to fix the humeroradial joint during operation.Chi square test,Mann-Whitney U test and independent sample t-test were used to compare the gender,side,age,injury distance,operation time and fracture injury type（Bado type）,postoperative clinical Mackay score and Nakamura imaging rating between the observation group（using percutaneous Kirschner wire to fix the humeral and radial joint）and the control group（without percutaneous Kirschner wire to fix the humeral and radial joint）.The postoperative complications were evaluated by postoperative subluxation,nonunion and radial head development.Results:There was no significant difference in gender,side,age and fracture injury type（Bado classification）between the two groups.30 cases in the observation group were followed up for an average of 3.11 years.Mackay score in the observation group was excellent in24 cases,good in 4 cases and poor in 2 cases,with an excellent and good rate of 93.33%.Nakamura grade: excellent in 25 cases,good in 3 cases and poor in 2 cases,with an excellent and good rate of 93.33%;38 cases in the control group were followed up for an average of 3.70 years.Mackay score: 27 cases in the control group were excellent,8cases were good and 3 cases were poor,with an excellent and good rate of 92.10%.Nakamura grade of imaging: 34 cases were excellent,3 cases were good and 1 case was poor,with an excellent and good rate of 97.36%.There was no significant difference in Mackay score of elbow joint after operation（P > 0.05）;There was no significant difference in postoperative imaging rating（P > 0.05）.The median times from injury to operation were 6 months in the observation group and 2 months in the control group.There was significant difference between the two groups（P < 0.05）;In the observation group,there were 3 cases of subluxation,1 case of complete dislocation,2 cases of mild necrosis of the radial head and 1 case of nail canal infection;In the control group,there were 3 cases of subluxation,2 cases of complete dislocation,3 cases of nonunion and 2cases of abnormal enlargement of the radial head.Conclusions:In the treatment of missed Monteggia fractures in children,there is little difference in the overall prognosis between the use of percutaneous Kirschner wire fixation of humeroradial joint,but it has better curative effect for children with missed Monteggia fractures who have been shelved for a long time. |
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