Clinical Effect Of Manual Reduction Of Humeroradial Joint In The Treatment Of Type Ⅰ~Ⅲ Fresh Monteggia Fracture In Children

Objective:To evaluate the efficacy of closed reduction on the humeroradial joint in the treatment of Bado typeⅠ,ⅡandⅢfresh Monteggia fractures in children and investigate the effect of clinical factors,including Bado classification,age and time of treatment,on the success rate of closed reduction.Methods:From January 2014 to April 2019,88 children with fresh Monteggia fracture treated by manual reduction with plaster immobilization were retrospectively studied.All patients were followed up in the Children’s Hospital of Chongqing Medical University and Mackay criteria were used to evaluate the clinical effect.Radiographic data were collected and reviewed to assess the reduction of the humeroradial joint.All patients were followed up to evaluate the function of the elbow joint and forearm and to assess the risk factors related to the failure of reduction.The relation between successful manual reduction and factors of Bado fracture type（Ⅰ,Ⅱ,Ⅲ）,patient age（0¹ year,1³ years,3¹4 years）and the interval between the injury and the treatment（group A,1³ days;group B,3⁶ days;group C,6¹0 days）was analyzed.Results:Successful manual reduction was achieved in 79 children:26with Bado typeⅠMonteggia fractures,14 with Bado typeⅡand 39 with Bado typeⅢ.At the last follow-up,Mackay criteria showed satisfactory results.Additionally,3 cases of Bado typeⅠ,2 typeⅡand 4 typeⅢfailed in closed reduction who eventually achieved reduction through operative intervention.The success rate of manual reduction was 89.7%,87.5%and 90.7%in Bado typeⅠ,ⅡandⅢcases,respectively,revealing no significant differences among different Bado types（χ²=0.131,P=0.937）.Successful closed reduction was achieved in 13,38 and 28 children in the toddler,preschool and school period age groups,respectively.Among toddler,preschool and school period cases,there were 0,4 and 5 children,respectively,who needed surgical treatment after the failure of closed reduction,and the success rate was 100%,90.5%and 84.8%,respectively;there was no significant difference（χ²=2.375,P=0.305）.There were 67cases in group A,10 cases in group B,and 2 cases in group C that reached successful closed reduction.Additionally,4 cases in group A,1 case in group B,and 4 cases in group C reached successful reduction via surgery;the success rate of closed reduction in the three groups was 94.4%,90.9%,and 33.3%,respectively,and a significant difference was detected（χ²=22.464,P≤0.001）.In detail,there was no significant difference between groups A and B(P_AB=0.523);however,there were significant differences in the success rates between groups A and C and groups B and C(P_AC=0.001,P_BC=0.028).Conclusion:Closed reduction is a safe and effective method for treating Bado typeⅠ^Ⅲfresh Monteggia fractures in children.The reduction should be introduced as soon as possible once the diagnosis has been made.