Abstract
Introduction
Monteggia fracture-dislocation refers to traumatic ulnar fractures and dislocation of the radial head, which is one of the most frequently missed injuries, especially in children. The most widespread attitude towards chronic Monteggia lesion is the open reduction of the radial head associated with ulnar osteotomy with or without annular ligament reconstruction. Our study aimed to analyze the risk factors for redislocation after surgical management of chronic Monteggia lesion and the benefits of annular ligament reconstruction and radiocapitellar pinning in paediatric.
Materials and methods
We retrospectively reviewed patients treated with reconstruction surgery for chronic Monteggia fracture-dislocation in our department between 2005 and 2017, with a minimum two years’ follow-up. The reconstruction surgery included ulnar osteotomy performed in all patients, annular ligament repair or reconstruction or fixation of radiocapitellar joint, or radial osteotomy in some patients. We collected the related clinical data and evaluated the risk factors of redislocation using logistic regression analyses and a two-piecewise linear regression model with a smoothing function, after reconstruction.
Results
Throughout a mean six years’ follow-up (range, 2–14 years), 62 patients (42 males, 20 females; average age 6.49 years range, 2–13 years) were reviewed. Of the radiocapitellar joints, 16.1% was noted to have redislocation. Univariate risk analysis showed age, time from injury to surgery, and radial osteotomy were risk factors for a recurrent radiocapitellar redislocation. Time from injury to surgery was found to be independent predictor of redislocation in multivariate analysis. However, there were significant nonlinear associations between time from injury to surgery and redislocation in multivariate logistic regression analysis after multivariate adjustment (p for nonlinear = 0.023). Every one month increase was associated with a 1.37-fold increase in redislocation, in participants within one year after injury.
Conclusion
In conclusion, the surgery of chronic Monteggia fracture-dislocation should be done as quickly as possible within one year after injury. Associated annular ligament reconstruction or fixation of radiocapitellar joint does not seem to be helpful.
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Data availability
The datasets analyzed in this study are available from the corresponding author on reasonable request.
Code availability
Not applicable.
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Funding
2021 Shanghai Jiao Tong University “Jiaotong University Star” Program Medical-Industrial Cross-Research Fund (Grant No. YG2021QN47).
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All the authors participated in the design, interpretation of the studies, analysis of the data, and review of the manuscript. Jin FC and Li H did the design of the study and drafted the manuscript, Dai ZZ, Xu J, and Zhang ZQ reviewed the patients and analyzed the data; Li H and Jin FC wrote the manuscript. All the authors read and approved the final manuscript.
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This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study received approval from the Institutional Review Board/Ethics Committee of Xin-Hua Hospital (Approval number: XHEC-D-2021–098).
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Dai, ZZ., Xu, J., Zhang, ZQ. et al. Risk factors for redislocation of chronic Monteggia fracture-dislocation in children after reconstruction surgery. International Orthopaedics (SICOT) 46, 2299–2306 (2022). https://doi.org/10.1007/s00264-022-05473-3
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DOI: https://doi.org/10.1007/s00264-022-05473-3