From 1980 to 1992, 62 cases of Monteggias fracture in children were treated byoperation, in which were 18 cases were fresh, 44 old. The following procedure performed separately: the reduction of the head of radius; the use of internal fixation following anatomical reduction of the ulna or the osteotomy of the ulna and elongation; the repair or reconstruction of annular ligament of the superior radioular joint. From the last follwup, 93 percent was excellent in the clinical result. The operative method was introduced briefly. The importance of earlydiagnosis and prompt effective treatment of Monteggias fracture in children was discussed. The key to prevent redislocation of the head of radius was that rigid fixation of ulna and repair or reconstruction of the annular ligament of radius were important. It is also important to improve curative effect that early functional movement after operation was mandatory for good operative results.
Objective To investigate the operative procedure and the short-term therapeutic effects of medial plantar venous flaps for estoration of soft-tissue defects on the volar aspect of fingers. Methods From May 2007 to July 2009, 13 cases (15 fingers) of volar soft tissue defects were treated with medial plantar venous flaps, including 7 males (9 fingers) and 6 females(6 fingers) with an average age of 30 years (range, 17-55 years). Soft tissue defects were caused by electric saws in 4 cases (5 fingers), by crush injury in 6 cases (6 fingers), and by burned scar removal in 3 cases (4 fingers). The size of soft tissue defects ranged from 1.0 cm × 0.9 cm to 5.8 cm × 3.3 cm, included 5 thumbs, 3 index fingers, 3 l ittle fingers, 2 ring fingers, and 2 middle fingers. The emergency surgical treatment was performed in 10 traumatic cases after 2 to 12 hours (4 hours on average); and the elective surgical treatment was performed in the other 3 cases of scar after burn. The 15 medial plantar venous flaps, with size of 1.0 cm × 1.0 cm to 6.0 cm × 3.5 cm, were harvested to restore defects. Of them, 12 venous flaps had 1 superficial vein and the other 3 had 2 veins; and the veins of 13 venous flaps bridged a single digital artery and the veins of the other 2 flaps bridged both arteries. The donor sites were sutured directly or were covered with skin graft. Results All 15 venous flaps survived completely, and the donor and reci pient sites healed by first intention. Eleven cases (11 fingers) were followed up for 2 to 12 months. The texture and color of the flaps were similar to those of adjacent normal skin with a satisfactory appearance. The two-point discrimination was 6-9 mm. According to criterion for joint junction of total active range of motion/total active range of flexion, the results were excellent in 10 cases and good in 1 case; the excellent and good rate was 100%. Conclusion The medial plantar venous flap has advantages of easy-to-operate, rich blood supply and high survival rate. So it is an ideal and rel iable choice for volar soft tissue defects of fingers.