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Management of acute length-unstable monteggia fractures in children:A case report

World Journal of Orthopedics 2021年第11期12卷 954-960页

作者： Francesco Roberto Evola Giovanni Francesco Di Fede Santo Bonanno Giuseppe Evola Maria Elena Cucuzza Department of Surgery Division of Orthopedics and Trauma Surgery“Cannizzaro”HospitalCatania 95100Italy Radiodiagnostics Department Division of Radiology“S.Marta and S.Venera”HospitalAcireale 95024Italy Emergency Department Division of First Aid“Garibaldi”Hospitalcatania 95124CataniaItaly General and Emergency Surgery Department Division of Surgery“Garibaldi”HospitalCataniaItalyCatania 95124Italy Maternity-Childhood Department Division of Paediatrics“Cannizzaro”HospitalCatania 95124Italy

BACKGROUND monteggia fractures are uncommon injuries in paediatric age.Treatment algorithms assert that length-unstable fractures are treated with plate fixation.In this case report,intramedullary fixation of an acute length-unstable monteggia fracture allowed a stable reduction to be achieved,along with an appropriate ulnar length and alignment as well as radio capitellar reduction despite the fact that the orthopaedic surgeon did not use a plate for the ulnar fracture.The scope of treatment is to avoid the use of a plate that causes periosteal stripping and blood circulation disruption around the fracture.CASE SUMMARY A four-year-old girl presented at the Emergency Department following an accidental fall off a chair onto the right forearm.The X-ray highlighted a lengthunstable acute Bado type 1 monteggia fracture of the right forearm.On the same day,the patient underwent surgical treatment of the monteggia fracture.The surgeon preferred not to use a plate to avoid a delay in fracture healing and to allow the micromotion necessary for callus formation.The operation comprised percutaneous fixation with an elastic intramedullary K-wire of the ulnar fracture and,subsequently,humeroradial joint reduction through manual manipulation.The orthopaedic surgeon assessed the stability of the radial head reduction under fluoroscopic control through flexion,extension,pronation and supination of the forearm.Healing of the fracture occurred within six weeks after surgery,as indicated by the presence of calluses on at least three cortices on standard radiographs.Dislocation/subluxation or loss of ulnar reduction was not apparent at the final X-ray examination.CONCLUSION Intramedullary fixation of unstable monteggia fractures results in excellent outcomes,provides reliable reduction and causes fewer complications.

关键词： monteggia fractures Children Management Outcome Case report

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