Surgical treatment of special Monteggia equivalent fractures in children

Abstract

Objective To explore the injury mechanism, treatment and prognosis of head-neck separation type among Monteggia equivalent fractures in children. Methods A retrospective study was conducted for 15 children of head-neck separation type fractures treated between January 2000 to December 2013. There were 3 boys and 12 girls with an average age of 8.7 (5.1-13) years. The injuries were located at left (n=11) and right (n=4) sides. The lesion was characterized by a fracture of ulnar diaphysis with a separated fracture of radial neck without a dislocation of radial head. And a line appeared through the longitudinal axis of radius off the center of capitellum. The classification was based on the direction of displacement and angulation of fractures. Nine cases belonged to type Ⅰ with an ulnar fracture with ulnar and palmar angulation plus radial neck fracture with ulnar and palmar displacement of distal end. And another 6 cases were classified as type Ⅱ with a direction of fracture displacement was opposite to that of type Ⅰ. The fractures of ulna were fixed with plate, Kirschner wire or elastic stable intramedullary nail. And the fractures of radial neck were fixed with Kirschner wire or elastic stable intramedullary nail. Reduction was evaluated by postoperative radiology and the therapeutic outcomes were assessed by the scheme of Bruce-Harvey-Wilson. Results The average follow-up period was 27 (11-60) months. The postoperative radiographs were used to evaluate the reductions of ulnar fractures. And the outcomes were good (n=13) and fair (n=2). According to the M taizeau criteria, the outcomes of radial neck fracture were good (n=14) and fair (n=1). According to the Bruce-Harvey-Wilson scoring system, the efficacies were excellent (n=13), good (n=1) and fair (n=1) at the last follow-up. Avascular necrosis occurred in 1 case and another case showed bulk formation of proximal metaphysis. Conclusions The head-neck separation type among Monteggia equivalent fractures have unique mechanisms. Timely diagnosis, prompt reduction, rigid fixation of ulnar fracture, anatomical reduction of radial neck fracture and early exercises may achieve a fair prognosis with fewer complications. Key words: Monteggia's fracture; Radius fractures; Fracture fixation; Child