CLASSIFICATION AND TREATMENT OF MONTEGGIA EQUIVALENT FRACTURES IN CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YU Tieqiang , ZUO Yuming , WANG Yueguang , ZHOU Hongyan , WANG Guoqiang , YI Fan , ZHANG Lei , WANG Jing , XING Aichun , MA Jianfeng.

Department of Pediatric Orthopaedics, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China. Corresponding author: YU Tieqiang, E-mail: unicornfly@live.cn;

Corresponding author：

Keywords：

Monteggia equivalent fracture; Fracture classification Internal fixation; Children

DOI：

10.7507/1002-1892.20130286

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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.

Citation： YU Tieqiang,ZUO Yuming,WANG Yueguang,ZHOU Hongyan,WANG Guoqiang,YI Fan,ZHANG Lei,WANG Jing,XING Aichun,MA Jianfeng.. CLASSIFICATION AND TREATMENT OF MONTEGGIA EQUIVALENT FRACTURES IN CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(11): 1309-1312. doi: 10.7507/1002-1892.20130286 Copy

1.	Bado JL. The Monteggia lesion. Clin Orthop Relat Res, 1967, (50): 71-86.
2.	Jamses HB, James RK. Fractures in Children. 7th ed. Philadelphia: Lippincott Williams&Wilkins, 2010: 446-450.
3.	Sferopoulos NK. Monteggia type IV equivalent injury. Open Orthop J, 2011, 5: 198-200.
4.	Güven M, Eren A, Kadioğlu B, et al. The results of treatment in pediatric Monteggia equivalent lesions. Acta Orthop Traumatol Turc, 2008, 42(2): 90-96.
5.	Ravessoud FA. Lateral condylar fracture and ipsilateral ulnar shaft fracture: Monteggia equivalent lesions? J Pediatr Orthop, 1985, 5(3): 364-366.
6.	Arora S, Sabat D, Verma A, et al. An unusual monteggia equivalent: a case report with literature review. J Hand Microsurg, 2011, 3(2): 82-85.
7.	Sood A, Khan O, Bagga T. Simultaneous monteggia type I fracture equivalent with ipsilateral fracture of the distal radius and ulna in a child: a case report. J Med Case Reports, 2008, 2: 190.
8.	Gaston MS, Irwin GJ, Huntley JS. Lateral condyle fracture of a child’s humerus: the radiographic features may be subtle. Scott Med J, 2012, 57(3): 182.
9.	Fowles JV, Kassab MT. Observations concerning radial neck fractures in children. J Pediatr Orthop, 1986, 6(1): 51-57.
10.	Klitscher D, Richter S, Bodenschatz K, et al. Evaluation of severely displaced radial neck fractures in children treated with elastic stable intramedullary nailing. J Pediatr Orthop, 2009, 29(7): 698-703.
11.	Toh S, Tsubo K, Nishikawa S, et al. Long-standing nonunion of fractures of the lateral humeral condyle. J Bone Joint Surg (Am), 2002, 84-A(4): 593-598.
12.	张立军, 吉士俊. 重视肱骨外髁骨折的规范化治疗. 中国矫形外科杂志, 2012, 20(18): 1633-1637.
13.	Thomas DP, Howard AW, Cole WG, et al. Three weeks of Kirschner wire fixation for displaced lateral condylar fractures of the humerus in children. J Pediatr Orthop, 2001, 21(5): 565-569.
14.	Sharma H, Sibinski M, Sherlock DA. Outcome of lateral humeral condylar mass fractures in children associated with elbow dislocation or olecranon fracture. Int Orthop, 2009, 33(2): 509-514.
15.	Buijze G, Kloen P. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg (Am), 2009, 91(10): 2416-2420.
16.	Baecher N, Edwards S. Olecranon fractures. J Hand Surg (Am), 2013, 38(3): 593-604.
17.	Siebenlist S, Schmidt-Horlohé K, Hoffmann R, et al. Proximal ulna fractures. Z Orthop Unfall, 2011, 149(3): e1-e19.
18.	Givon U, Pritsch M, Levy O, et al. Monteggia and equivalent lesions. A study of 41 cases. Clin Orthop Relat Res, 1997, (337): 208-215.

1. Bado JL. The Monteggia lesion. Clin Orthop Relat Res, 1967, (50): 71-86.
2. Jamses HB, James RK. Fractures in Children. 7th ed. Philadelphia: Lippincott Williams&Wilkins, 2010: 446-450.
3. Sferopoulos NK. Monteggia type IV equivalent injury. Open Orthop J, 2011, 5: 198-200.
4. Güven M, Eren A, Kadioğlu B, et al. The results of treatment in pediatric Monteggia equivalent lesions. Acta Orthop Traumatol Turc, 2008, 42(2): 90-96.
5. Ravessoud FA. Lateral condylar fracture and ipsilateral ulnar shaft fracture: Monteggia equivalent lesions? J Pediatr Orthop, 1985, 5(3): 364-366.
6. Arora S, Sabat D, Verma A, et al. An unusual monteggia equivalent: a case report with literature review. J Hand Microsurg, 2011, 3(2): 82-85.
7. Sood A, Khan O, Bagga T. Simultaneous monteggia type I fracture equivalent with ipsilateral fracture of the distal radius and ulna in a child: a case report. J Med Case Reports, 2008, 2: 190.
8. Gaston MS, Irwin GJ, Huntley JS. Lateral condyle fracture of a child’s humerus: the radiographic features may be subtle. Scott Med J, 2012, 57(3): 182.
9. Fowles JV, Kassab MT. Observations concerning radial neck fractures in children. J Pediatr Orthop, 1986, 6(1): 51-57.
10. Klitscher D, Richter S, Bodenschatz K, et al. Evaluation of severely displaced radial neck fractures in children treated with elastic stable intramedullary nailing. J Pediatr Orthop, 2009, 29(7): 698-703.
11. Toh S, Tsubo K, Nishikawa S, et al. Long-standing nonunion of fractures of the lateral humeral condyle. J Bone Joint Surg (Am), 2002, 84-A(4): 593-598.
12. 张立军, 吉士俊. 重视肱骨外髁骨折的规范化治疗. 中国矫形外科杂志, 2012, 20(18): 1633-1637.
13. Thomas DP, Howard AW, Cole WG, et al. Three weeks of Kirschner wire fixation for displaced lateral condylar fractures of the humerus in children. J Pediatr Orthop, 2001, 21(5): 565-569.
14. Sharma H, Sibinski M, Sherlock DA. Outcome of lateral humeral condylar mass fractures in children associated with elbow dislocation or olecranon fracture. Int Orthop, 2009, 33(2): 509-514.
15. Buijze G, Kloen P. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg (Am), 2009, 91(10): 2416-2420.
16. Baecher N, Edwards S. Olecranon fractures. J Hand Surg (Am), 2013, 38(3): 593-604.
17. Siebenlist S, Schmidt-Horlohé K, Hoffmann R, et al. Proximal ulna fractures. Z Orthop Unfall, 2011, 149(3): e1-e19.
18. Givon U, Pritsch M, Levy O, et al. Monteggia and equivalent lesions. A study of 41 cases. Clin Orthop Relat Res, 1997, (337): 208-215.

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CLASSIFICATION AND TREATMENT OF MONTEGGIA EQUIVALENT FRACTURES IN CHILDREN

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