[Classification and treatment of Monteggia equivalent fractures in children]

Tieqiang Yu, Yuming Zuo, Yueguang Wang, Hongyan Zhou, Guoqiang Wang, Fan Yi, Lei Zhang, Jing Wang, Aichun Xing, Jianfeng Ma
Chinese Journal of Reparative and Reconstructive Surgery 2013, 27 (11): 1309-12

OBJECTIVE: To investigate the classification and treatment of Monteggia equivalent fractures in children.

METHODS: A retrospective analysis was made on the clinical data of 35 cases of Monteggia equivalent fractures between January 2008 and January 2012. There were 17 boys and 18 girls with an average age of 7 years and 5 months (range, 1 year and 2 months to 14 years and 11 months). The causes of injury were tumbling injury in 25 cases, falling injury in 3 cases, and sport injury in 7 cases. The disease duration from injuries to admission ranged from 1 hour to 16 days (median, 28 hours). According to the criteria of self-made classification, there were 22 cases of type I (ulnar fracture with radial neck fracture or proximal radial epiphysis injury), 2 cases of type II (posterior elbow dislocation with radial neck fracture or proximal radial epiphysis injury), 10 cases of type III (ulnar fracture and/or olecranon fracture with humeral lateral condylar fracture), and 1 case of type IV (fractures of radius and ulna with radial neck fracture or proximal radial epiphysis injury). All patients were treated by open reduction and internal fixation/external fixation.

RESULTS: All incisions healed by first intention without infection. Thirty-four cases were followed up 14 months on average (range, 12-18 months). All fractures healed at 2.5 months on average (range, 6 weeks to 5 months). According to Hospital for Special Surgery (HSS) score system, the results were excellent in 29 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 94%. No cubit varus/valgus or delayed ulnar nerve injury was observed.

CONCLUSION: New self-made classification is simple and easy to remember, and it is helpful to reduce omission diagnose rate and select therapeutic methods. Surgery is an effective method to treat Monteggia equivalent fractures.

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