Therefore, we decided to compare the pre-op PUL to the final follow-up PUL, trying to reveal the proportional change of ulna and radius in CMF for the first time and to evaluate it as useful parameter in preoperative planning. The basic pathological state in CMF is the mismatches of radius and ulna, our team reported the proportional ulnar length (PUL), defined as the length of the ulna/length of the radius, consistently averaged approximately 1.1 in healthy children ( 11). Currently, the recognized factors related to postoperative elbow performance include age, interval, the presence of deformity of ulna, and degree of neck-shaft angle asymmetry ( 10). There are many factors that correlated with the therapeutic effect. Although most authors reported improved outcomes after surgery, the rate of complications and recurrent instability is the common frustrating challenges. Many surgery options have been reported, such as closed or open reduction of the radial head whether the annular ligament is reconstructed, if required, what materials will be used and different osteotomy ways of the ulna, the different fixation methods ( 7- 9). However, in the last years, most orthopedists recommended that surgical treatment is the best option for skeletally immature children. The treatment of chronic Monteggia fracture-dislocation (CMF) in children remains controversial and challenging for surgeons. The neglected lesion's common presentation is bony prominence, limited range of motion (ROM), valgus deformity of the elbow, with or without elbow pain, limited supination and pronation of the forearm, and neurological problems ( 3- 6). However, many of these injuries in children are chronic at initial presentation, for inadequate radiographs, missing subtle greenstick fractures of the ulna and bowing of the ulna ( 2). When the Monteggia lesion is identified in an acute situation, the outcomes are always achieved well. Monteggia fracture-dislocation, first described by Giovanni Monteggia in 1814, is a fracture of the ulna associated with dislocation of the radiocapitellar joint and disruption of the proximal radioulnar joint ( 1). Keywords: Chronic Monteggia fracture children open surgery PUL is a useful parameter in evaluating the mismatch between ulna and radius in CMF. With the extension of the interval, it is more necessary to increase the lengthening and angulation in positive proportion. Stabilization of the radial head with adequate elongation and balanced angulation of the osteotomy through direct observation is the main way to ensure and maintain satisfactory outcomes. The PUL and MID were significantly increased from 1.06☐.03 and 1.11☐.26 to 1.13☐.11 (P=0.047) and 1.28☐.27 (P=0.021), separately.Ĭonclusions: We highlight ulnar osteotomy as the essential procedure during reconstruction surgeries. The lengthening of the ulna was proportional to the magnitude of angulation of the ulna (r=0.648, P=0.004), and a positive correlation was also seen between the lengthening and the interval (r=0.632, P=0.005) and the angulation and the interval (r=0.502, P=0.034). The mean posterior bending angle was 12.88° (range, 3 to 25°), and the mean amount of elongation of the ulna was 8.78 mm (range, 3.61 to 17.52 mm). A good reduction was observed in 15 (83.33%) patients, while 3 (16.67%) patients were fair. Results: The mean interval was 11.1 months and the follow-up time was 46.6 months. The relationship between the lengthening and angulation of ulna and the interval was calculated. Parameters were compared at the time of pre-operation and the last follow-up. The final reduction statuses of the radial head were reviewed. Radiographic parameters of maximum interosseous distance (MID), proportional ulnar length (PUL), lengthening, and bending angle of the ulna were summarized. Electronic medical records of Bado type, complaints, Kim scores, and complications were recorded. Methods: We retrospectively reviewed 18 children with a mean age of 6.78☒.67 years old who underwent surgical treatment because of CMF. We describe our initial experience with ulnar osteotomy and angulation on correction with modified open surgery and evaluate outcomes from clinical and radiographic findings. Interviews with Outstanding Guest Editorsīackground: The treatment of chronic Monteggia fracture-dislocation (CMF) remains controversial and challenging for surgeons.Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process.
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