Ulnar oblique osteotomy followed by plating versus no plating in treatment of obsolete Monteggia fractures in children

Abstract

Objective To compare the clinical efficacy of plating versus non-plating following ulnar oblique osteotomy in the treatment of obsolete Monteggia fractures in children.Methods Clinical data of 33 patients were reviewed who had been treated for obsolete Monteggia fracture in our department from January 2001 to June 2011.They were 23 males and 10 females,aged from 4 to 13 years (average,8.1 years).According to the Bado classification,23 cases were type Ⅰ,4 type Ⅱ and 6 type Ⅲ.Ulnar oblique osteotomy was performed in all the 33 cases to extend the ulna lengthways,but their subsequent fixation was different.In the non-plating group (17 cases),after reduction of the radial head,a supplementary transfixation of the radius was performed with a Kirschner wire through the capitellum,and the excised ulna was free of fixation.In the plating group (16 cases),after transfixation of the radius with a Kirschner wire through the capitellum,plating was performed of the excised ulna.Both groups were immobilized in a plaster cast after surgery.The 2 groups were compared with respect to healing time for the ulnar osteotomy and the Mackay scoring for postoperative elbow function.The 2 groups were comparable with no significant difference in the general data (P ＞ 0.05).Results Follow-ups for an average of 1.5 years (from 10 months to 3 years) revealed no incision infection and ulnar healing in all the patients.The average ulnar healing time for the non-plating group (7.2 ± 1.1 weeks) was significantly shorter than for the plating group (8.5 ± 1.8 weeks) (P ＜ 0.05).In the non-plating group,l0 cases were rated as excellent,5 good and 2 poor; in the plating group,11 cases were rated as excellent,4 good and one poor.In either of the 2 groups,3 cases reported residual pain in elbow motion.The non-plating group reported one case of dislocation of the capitellum.Conclusion Non-plating after ulnar osteotomy may be used as a treatment of obsolete Monteggia fractures in children,because it has advantages of less invasion to the ulnar blood supply,shortened operation time and healing time. Key words: Forearm injuries; Osteotomy; Fracture fixation, internal; Child