The Clinical Study Of Monteggia Fracture Without Surgical Treatment In Children

Objective: To analysis the clinical features, conservative treatment's advantages compared with surgical treatment for the fresh Monteggia's fracture in children. And to evaluate the factors affecting reduction and prognosis of Monteggia fracture.Materials and Methods: A retrospective study for 72 patients of fresh Monteggia's fractures in children who were treated in our hospital from May 2006 to June 2010 and were followed up. 6 cases of them had the never injuried clinical menifetation .46 cases of them were treated conservatively and these patients are regarded as group of A; 26 cases of them were treated with surgical treatment and these patients are regarded as group of B. Fixation measures conclude TEN / Kirschner wire/steel plate or annular ligament and joint capsule repaired were added. Stage functional exercises were taken in the late stage.We measured the injured elbow flexion and extension/ rotation range, and measured the activities of the contralateral normal elbow flexion and extension / rotation range during follow-up . Calculated the motion score and elbow function score (JOA)of each patient. And calculated the elbow functional assessment by Li Hanmin's elbow function classification. We make the statistical analysis for the two groups.Results: All patients were followed up for 8 months to 4 years 6 months (average 3.2 years). According to Li Hanmin's elbow function classification , the group of A was classificed, 37 excellent , 7 good, 2 fair , and no poor case . the excellent and good rate is 95.7%, the group of B , 14 excellent, 4 good, 3 fair , no poor case, excellent and good rate of 84.5%, the elbow function of group A is better than the group of B (P <0.05); All of the cases of nerve injury were relieved nerve exploration, observated by 3 month to 6 months, returned to normal.Conclusions: 1.The Monteggia's fracture in children should first be treated conservatively. The outcome of the group of conservative treatment is better than the control group of surgical treatment. 2. Reduction should be given as soon as possible ,to avoid artificially extend the time of treatment.3. After analyzing the actors which effect reduction and then decide the next treatment in those patients who are unable to have a successful reduction with manipulative reduction. 4. Most of the neurologic complication following Monteggia fractures need not never exploration, and most of them can get recovery between one to three months. If they can't get recovery after tsix months, we should take the surgical operation to explore the never. 5.The stage functional exercise is very important to enhance the excellent and good rate of elbow function in the late stage.