| Objectives:Monteggia fracture initially involves approximately 1/3 fracture of the ulnar shaft combined with dislocation of the radial head,which is a rare injury in children,accounting for 1%of all forearm fractures in children.16%-33%of these injuries are missed at the initial onset.For missed Monteggia fracture is missed for more than 3 weeks,the radial head is difficult to reduce,ulnar deformity has formed,and ulnar osteotomy is required.At present,there is no consensus on the selection of ulnar osteotomy point.This paper aims to make a horizontal comparison of the prognosis of children with missed Monteggia fracture admitted to our hospital,and analyze whether different osteotomy points have an impact on the prognosisMethods:A retrospective cohort study was conducted to analyze the clinical data of 68 children with missed Monteggia fracture admitted to our hospital from June 2015 to June 2021,including 42 males and 26 females,aged from 3 to 12 years old,with an average of(6.6 ± 2.4)years old.The interval from injury to operation was 1 month to 60 months(mean,8.6 months).According to Bado classification,60 cases were type Ⅰand 8 cases were type Ⅲ.Operation time:42 minutes to 179 minutes,mean(95±29.2)minutes.All patients were treated with proximal ulna osteotomy.According to the ratio of the length from proximal ulna to the osteotomy point to the length of ulna,the patients were divided into 3 groups,which are Group A,GroupB and Group C.Observation indicators:(1)The basic clinical data of the three groups were compared;(2)The operation time of the three groups was compared.To observe the recovery of brachioradial relationship,the healing of ulnar osteotomy and the occurrence of complications.(3)Regular follow-up after surgery.Before taking out the internal fixation,elbow pronation,supination,elbow extension and elbow flexion angles of the three groups were measured and compared;Kim Elbow function Scale was used to evaluate elbow function,and the recovery situation of elbow function in the three groups was compared.After the internal fixation was removed,the elbow function was evaluated by imaging Nakamura grading standard,and the recovery of elbow function was compared among the 3 groups.Results:There were no significant differences in gender,age,side of affected limb,fracture type,time from injury to operation,preoperative elbow motion of affected limb and other basic data among the 3 groups(all P values>0.05).The operation time of group A was(100.6±31.7)min,group B was(133±24.2)min,and group C was(94.9±28.6)min.There was no statistical significance in the operation time between the three groups(all P values>0.05).Reexamination on the third postoperative day of the elbow joint anteroposterior and lateral radiographs showed that the brachioradial relationship was restored to normal.In group A,incision infection was found in 1 case during dressing change after operation,which healed after anti-inflammatory treatment.All 68 patients were followed up for 6-36 months,with an average of 8.7 months.Postoperative redislocation of brachioradialis joint occurred in 3 cases and subluxation in 3 cases in group A.Subluxation occurred in 3 cases in group B;Subluxation occurred in 2 cases and delayed ulna healing in 1 case in group C:there was no significant difference in the incidence of complications among the 3 groups(all P values were 1).There was no significant difference in the healing time of ulnar osteotomy between the three groups(F=0.011,P=0.989).There were no significant differences in pronation,supination,elbow extension,elbow flexion Angle,and Kim’s elbow function evaluation between the three groups(all P values>0.05).There was no significant difference in postoperative radiographic Nakamura grading of elbow function among the three groups(P=0.422).Conclusion:In the surgical treatment of children with missed Monteggia fracture,the choice of different osteotomy points has no significant effect on the prognosis. |
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