Analysis Of The Therapeutic Effect Of Two Methods Of Ulna Fixation In The Treatment Of Old Monteggia Fracture In Children

Objective.Generally,monteggia's fracture refers to the ulnar fracture with radial head dislocation.Complicated injury mechanism with clinical manifestations in children Monteggia's fracture results in misdiagnosis or missed diagnosis.Children are a special group,the bone's growing development is special.Then the old Monteggia fracture emerged.During the acute phase,Monteggia fracture can use the expectant treatment with closed reduction of radial head and plaster immobilization and can get a satisfied result.Misdiagnosis or missed diagnosis in the acute phase,then leads to the old Monteggia fracture.Some scholars believe that after two weeks of the injury without dealing,then the injury get obsolete.The old Monteggia fracture get poor effect after using the expectant treatment.So that,about the old Monteggia fracture now reach an agreement of surgical treatment.Osteotomy of ulna,humeroradial joint open reduction,annular ligament reconstruction,can achieve satisfactory results.But the method of ulna fixation is different.In this study,we use two methods to fix the ulna,reconstruction plate and external fixator.By evaluating the prognosis to analyse the therapeutic effect of two methods.Methods.Depending on retrospective analysis,we reviewed cases operated on obsolete Monteggia fractures in children from March 2011 to April 2015 in Qilu Hospital Of Shangdong University.Those patients were treated with orthopaedic osteotomy of ulna and the annular ligament is reestablished.13 patients use the reconstruction plate to fix the ulna,20 patients use the external fixator.These cases were divided into two groups.One was that the ulna is fixed with the reconstruction plate and we call it reconstruction plate group,the other was that the ulna is fixed with the external fixator and we call it external fixator group.Two groups of children aged 2?15 years old,the average age was 7 years;The medical history was 3 months?2 years,the average history of about 1 years.Among the reconstruction plate group,3 cases were female patients,10 cases were male patients;Among the external fixation group,4 cases were female patients,16 cases were male patients.Among the reconstruction plate group,2 cases was the left limb,and 11 cases was the right limb.Among the external fixation group,3 cases was the left limb,and 17 cases was the right limb According to Bado classification of Monteggia fracture,10 cases were type I Bado and 3 cases were Bado type III in reconstruction plate group,16 cases were type I Bado and 4 cases were Bado type III in external fixation groupAfter second days,seven days of surgery,those cases took X-ray radiograph including elbow and limb forearm.After 1 months,2 months,3 months,6 months of the surgery,those cases got outpatient review,then,after every 6 months those cases got outpatient review.The operative time,intraoperative blood loss,postoperative elbow joint swelling index,postoperative hospitalization were used as the recent effect evaluating indicator.Postoperative outpatient review score according to Mayo Elbow function standard(MEPs)was used to evaluate the long-term effects.Result.Two groups of patients were followed up for 2 years-6 years,an average of 4 years of follow-up.Results:the average operation time of external fixator group(ignoring the surgery before anesthesia and anesthesia recovery time)was about 2.5 hours,the average amount of bleeding was about 30ml,after seven days of surgery,elbow joint swelling decreased significantly than the first postoperative day;ON the other hand,the average operation time of reconstruction plate group was about 3.5 hours,the average amount of bleeding was about 70ml,after seven days of surgery,elbow joint swelling don't decrease obviously.After one,two,three,six months,then,after every 6 months those cases got outpatient review,according to the Mayo standard for evaluation of elbow function,external fixation group shows that better than good in 16 cases,be good in 3 cases,be ok in 1 case,be poor in 0 case;reconstruction plate group shows that better than good in 8 cases,be good in 2 cases,be ok in 1 case,be poor in 2 case;Be poor in 2 cases,the X-ray shows the dislocation of the radial head.Conclusion.Old Monteggia fracture in children treated by surgery,for ulna osteotomy,humeroradial joint open reduction,annular ligament repair or reconstruction,can achieve satisfactory effect.The osteotomy of ulna by external fixator fixation comparing with reconstruction plate fixation has more advantages,simple operation procedure,shorter operation time,little injury of soft tissue and ulna,rapid postoperative recovery,shorter hospitalization time,and better recovery of long-term elbow function.We have reason to believe that the method of ulna osteotomy and external fixation surgery can achieve better results in the treatment of old Monteggia fracture in children.This method is worth promoting.