Top

Journal of Orthopaedics and Traumatology

Published in:

Open Access 01-12-2024 | Original article

Risk factors for proximal radial abnormalities in children with untreated chronic Monteggia fractures: a review of 142 cases

Authors: WenTao Wang, QianQian Mei, Hang Liu, YueMing Guo, HaiBo Mei, Federico Canavese, Antonio Andreacchio, HanQing Lyu, ShunYou Chen, ShengHua He

Published in: Journal of Orthopaedics and Traumatology | Issue 1/2024

Abstract

Background

The risk factors for proximal radial abnormalities (PRA) in paediatric patients with untreated chronic Monteggia fractures (CMFs) are unclear. This multicentre study aimed to evaluate the risk factors for PRA in children with untreated CMFs.

Materials and methods

The clinical data of 142 patients (mean age at the time of injury: 5.73 years) with untreated unilateral CMFs were retrospectively reviewed. The radial neck-shaft angle (RNS_AP) and radial head size (RH_L) were measured on anteroposterior (AP) and lateral (L) radiographs, respectively. The RH_L size was the ratio of the widest width of the proximal radial metaphysis to the narrowest radial neck width. The En-RNS_AP and En-RH_L were the ratios of the enlargement (En) of the RNS_AP angle and RH_L size of the injured elbow to those of the uninjured elbow, respectively. Paired-sample t-tests, single-factor analyses and multiple linear regression analyses were performed to evaluate the correlation between the differences in these parameters between the injured and uninjured elbows and the assessed risk factors. These risk factors included institution, sex, laterality, age at injury, time from injury to diagnosis, direction of RH dislocation, distance of RH dislocation (DD-RH), presence of radial or median nerve injury, heterotopic ossification and immobilization of the elbow after injury.

Results

In children with untreated CMFs (mean time from injury to diagnosis: 14.6 months), Student’s t-test revealed a significant difference in the RH_L size (P < 0.001) but not in the RNS_AP angle (P = 0.075) between the injured and uninjured elbows. Pearson correlation analysis revealed a potential correlation between En-RH_L and age at the time of injury (P = 0.069), time from injury to diagnosis (P < 0.001) and DD-RH (P < 0.001), excluding other risk factors (P > 0.05). Multiple linear regression analysis revealed that age at the time of injury (P = 0.047), time from injury to diagnosis (P = 0.007) and DD-RH (P = 0.001) were risk factors for an increased En-RH_L in patients with untreated CMFs; the variability in En-RH_L among the other three risk factors was 21.4%.

Conclusions

In paediatric patients with unilateral untreated CMFs, PRA of the injured elbow consisted mainly of RH enlargement or radial neck narrowing rather than valgus deformities of the proximal radius. Older age at injury, increased time from injury to diagnosis and DD-RH were risk factors for more severe PRA.

Level of evidence

III.

Bado JL (1967) The Monteggia lesion. Clin Orthop Relat Res 50:71–86CrossRefPubMed

Kay RM, Skaggs DL (1998) The pediatric Monteggia fracture. Am J Orthop 27:606–609PubMed

Bae DS (2016) Successful strategies for managing Monteggia injuries. J Pediatr Orthop 36(Suppl 1):S67–S70. https://doi.org/10.1097/BPO.0000000000000765CrossRefPubMed

Goyal T, Arora SS, Banerjee S, Kandwal P (2015) Neglected Monteggia fracture dislocations in children: a systematic review. J Pediatr Orthop B 24:191–199. https://doi.org/10.1097/BPB.0000000000000147CrossRefPubMed

Liao S, Pan J, Lin H, Xu Y, Lu R, Wu J et al (2019) A new approach for surgical treatment of chronic Monteggia fracture in children. Injury 50:1237–1241. https://doi.org/10.1016/j.injury.2019.04.017CrossRefPubMed

Mohan Kumar EG, Yathisha Kumar GM, Noorudheen M (2019) Functional outcome of bell tawse procedure for the management of chronic unreduced Monteggia fracture-dislocation in children. Indian J Orthop 53:745–750. https://doi.org/10.4103/ortho.IJOrtho_47_19CrossRefPubMedPubMedCentral

Baydar M, Öztürk K, Orman O, Akbulut D, Keskinbıçkı MV, Şencan A (2022) Use of corrective ulnar osteotomy and radial head relocation into preserved annular ligament in the treatment of radiocapitellar instability secondary to pediatric chronic Monteggia fracture-dislocation. J Hand Surg Am 47:481.e1-481.e9. https://doi.org/10.1016/j.jhsa.2021.05.025CrossRefPubMed

Stragier B, De Smet L, Degreef I (2018) Long-term follow-up of corrective ulnar osteotomy for missed Monteggia fractures in children. J Shoulder Elbow Surg 27:e337–e343. https://doi.org/10.1016/j.jse.2018.06.029CrossRefPubMed

Kim HT, Conjares JN, Suh JT, Yoo CI (2002) Chronic radial head dislocation in children, part 1: pathologic changes preventing stable reduction and surgical correction. J Pediatr Orthop 22:583–590CrossRefPubMed

10.

Nakamura K, Hirachi K, Uchiyama S, Takahara M, Minami A, Imaeda T et al (2009) Long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in children. J Bone Joint Surg Am 91:1394–1404. https://doi.org/10.2106/JBJS.H.00644CrossRefPubMed

11.

Rahbek O, Deutch SR, Kold S, Søjbjerg JO, Møller-Madsen B (2011) Long-term outcome after ulnar osteotomy for missed Monteggia fracture dislocation in children. J Child Orthop 5:449–457. https://doi.org/10.1007/s11832-011-0372-0CrossRefPubMedPubMedCentral

12.

Ko KR, Shim JS, Park J, Won J (2022) Predictors of ideal outcomes after reconstructive surgery for chronic Monteggia fracture in children. J Orthop Sci 27:1025–1031. https://doi.org/10.1016/j.jos.2021.06.009CrossRefPubMed

13.

Cao S, Dong ZG, Liu LH, Wei JW, Luo ZB, Peng P (2022) Missed Monteggia fractures in children treated by open reduction of the radial head and corrective osteotomy of the ulna. Sci Rep 12:16819. https://doi.org/10.1038/s41598-022-21019-4CrossRefPubMedPubMedCentral

14.

Wang W, Xiong Z, Huang D, Li Y, Huang Y, Guo Y et al (2024) Risk factors for unsuccessful reduction of chronic Monteggia fractures in children treated surgically: a review of 209 cases. Bone Jt Open 5:581–591. https://doi.org/10.1302/2633-1462.56.BJO-2024-0004.R2CrossRefPubMedPubMedCentral

15.

Meyers C, Lisiecki J, Miller S, Levin A, Fayad L, Ding C et al (2019) Heterotopic ossification: a comprehensive review. JBMR Plus 3:e10172. https://doi.org/10.1002/jbm4.10172CrossRefPubMedPubMedCentral

16.

Foruria AM, Augustin S, Morrey BF, Sánchez-Sotelo J (2013) Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna. J Bone Joint Surg Am 95:e66. https://doi.org/10.2106/JBJS.K.01533CrossRefPubMed

17.

Kim HT, Can LV, Ahn TY, Kim IH (2017) Analysis of radiographic parameters of the forearm in traumatic radial head dislocation. Clin Orthop Surg 9:521–528. https://doi.org/10.4055/cios.2017.9.4.521CrossRefPubMedPubMedCentral

18.

Arrigoni C, Catena N (2022) Chronic Monteggia in pediatric population: a narrative literature review. Pediatr Med Chir. https://doi.org/10.4081/pmc.2022.289.10.4081/pmc.2022.289CrossRefPubMed

19.

Young S, Letts M, Jarvis J (2000) Avascular necrosis of the radial head in children. J Pediatr Orthop 20:15–18CrossRefPubMed

20.

Dimeglio A (2001) Growth in pediatric orthopaedics. J Pediatr Orthop 21:549–555CrossRefPubMed

21.

Ducan B, Lubchenco LO, Hansman C (1974) Growth charts for children 0 to 18 years of age. Pediatrics 54:497–502CrossRefPubMed

22.

Kalbitz M, Lackner I, Perl M, Pressmar J (2023) Radial head and neck fractures in children and adolescents. Front Pediatr 10:988372. https://doi.org/10.3389/fped.2022.988372CrossRefPubMedPubMedCentral

23.

Hell AK, von Laer L (2014) Wachstumsverhalten nach frakturen des proximalen radiusendes: unterschiede zum übrigen skelett [growth behaviour after fractures of the proximal radius: differences to the rest of the skeleton]. Unfallchirurg 117:1085–1091. https://doi.org/10.1007/s00113-014-2632-1CrossRefPubMed

24.

Vocke AK, von Laer LR (1998) Die prognose proximaler radiusfrakturen im wachstumsalter [prognosis of proximal radius fractures in the growth period]. Unfallchirurg 101:287–295. https://doi.org/10.1007/s001130050270CrossRefPubMed

25.

Schipani E, Ryan HE, Didrickson S, Kobayashi T, Knight M, Johnson RS (2001) Hypoxia in cartilage: HIF-1alpha is essential for chondrocyte growth arrest and survival. Genes Dev 15:2865–2876. https://doi.org/10.1101/gad.934301CrossRefPubMedPubMedCentral

26.

Brucker PU, Izzo NJ, Chu CR (2005) Tonic activation of hypoxia-inducible factor 1alpha in avascular articular cartilage and implications for metabolic homeostasis. Arthritis Rheum 52:3181–3191. https://doi.org/10.1002/art.21346CrossRefPubMed

27.

Arnett TR (2010) Acidosis, hypoxia and bone. Arch Biochem Biophys 503:103–109. https://doi.org/10.1016/j.abb.2010.07.021CrossRefPubMed

28.

Xu D, Gan K, Wang Y, Wu Z, Wang Y, Zhang S et al (2022) A composite deferoxamine/black phosphorus nanosheet/gelatin hydrogel scaffold for ischemic tibial bone repair. Int J Nanomedicine 17:1015–1030. https://doi.org/10.2147/IJN.S351814CrossRefPubMedPubMedCentral

29.

Galik K, Baratz ME, Butler AL, Dougherty J, Cohen MS, Miller MC (2007) The effect of the annular ligament on kinematics of the radial head. J Hand Surg Am 32:1218–1224. https://doi.org/10.1016/j.jhsa.2007.06.008CrossRefPubMed

30.

Xu G, Chen W, Yang Z, Yang J, Liang Z, Li W (2022) Finite element analysis of elbow joint stability by different flexion angles of the annular ligament. Orthop Surg 14:2837–2844. https://doi.org/10.1111/os.13452CrossRefPubMedPubMedCentral

31.

Li X, Han L, Nookaew I, Mannen E, Silva MJ, Almeida M et al (2019) Stimulation of piezo1 by mechanical signals promotes bone anabolism. Elife 8:e49631. https://doi.org/10.7554/eLife.49631CrossRefPubMedPubMedCentral

32.

Rosa N, Simoes R, Magalhães FD, Marques AT (2015) From mechanical stimulus to bone formation: a review. Med Eng Phys 37:719–728. https://doi.org/10.1016/j.medengphy.2015.05.015CrossRefPubMed

33.

Wang WT, Li YQ, Guo YM, Li M, Mei HB, Shao JF et al (2019) Risk factors for the development of avascular necrosis after femoral neck fractures in children: a review of 239 cases. Bone Joint J 101-B:1160–1167. https://doi.org/10.1302/0301-620X.101B9.BJJ-2019-0275.R1CrossRefPubMed

34.

Wang W, Li Y, Guo Y, Li M, Mei H, Shao J et al (2020) Initial displacement as a risk factor for avascular necrosis of the femoral head in pediatric femoral neck fractures: a review of one hundred eight cases. Int Orthop 44:129–139. https://doi.org/10.1007/s00264-019-04429-4CrossRefPubMed

35.

Zhang P, Liu X, Guo P, Li X, He Z, Li Z et al (2021) Effect of cyclic mechanical loading on immunoinflammatory microenvironment in biofabricating hydroxyapatite scaffold for bone regeneration. Bioact Mater 6:3097–3108. https://doi.org/10.1016/j.bioactmat.2021.02.024CrossRefPubMedPubMedCentral

36.

Wu J, Tang Y, Pu X, Wang M, Chen F, Chen X et al (2021) The role of micro-vibration parameters in inflammatory responses of macrophages cultured on biphasic calcium phosphate ceramics and the resultant influence on osteogenic differentiation of mesenchymal stem cells. J Mater Chem B 9:8003–8013. https://doi.org/10.1039/d1tb00898fCrossRefPubMed

37.

Delpont M, Jouve JL, de Sales Gauzy J, Louahem D, Vialle R, Bollini G et al (2014) Proximal ulnar osteotomy in the treatment of neglected childhood Monteggia lesion. Orthop Traumatol Surg Res 100:803–807. https://doi.org/10.1016/j.otsr.2014.06.022CrossRefPubMed

Title: Risk factors for proximal radial abnormalities in children with untreated chronic Monteggia fractures: a review of 142 cases
Authors: WenTao Wang
QianQian Mei
Hang Liu
YueMing Guo
HaiBo Mei
Federico Canavese
Antonio Andreacchio
HanQing Lyu
ShunYou Chen
ShengHua He
Publication date: 01-12-2024
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 1/2024
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1186/s10195-024-00793-z

Effect of different lumbar–iliac fixation and sacral slope for Tile C1.3 pelvic fractures: a biomechanical study

Open Access
Osteosynthesis
Original article

TikTok content as a source of health education regarding epicondylitis: a content analysis

Open Access
Epicondylitis
Original article

Comparison of survival, function and complication between intercalary frozen autograft versus massive allograft reconstruction after malignant bone tumors resection

Open Access
Original article

Optimizing periprosthetic fracture management and in-hospital outcome: insights from the PIPPAS multicentric study of 1387 cases in Spain

Open Access
Periprosthetic Fracture
Original article

Magnesium degradation-induced variable fixation plates promote bone healing in rabbits

Open Access
Original article

Preoperative antibiotic prophylaxis and the incidence of surgical site infections in elective clean soft tissue surgery of the hand and upper limb: a systematic review and meta-analysis

Open Access
Antibiotic
Systematic Review

Keynote series | Spotlight on menopause

Springer Medicine

Risk factors for proximal radial abnormalities in children with untreated chronic Monteggia fractures: a review of 142 cases

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

Other articles of this Issue 1/2024

Effect of different lumbar–iliac fixation and sacral slope for Tile C1.3 pelvic fractures: a biomechanical study

TikTok content as a source of health education regarding epicondylitis: a content analysis

Comparison of survival, function and complication between intercalary frozen autograft versus massive allograft reconstruction after malignant bone tumors resection

Optimizing periprosthetic fracture management and in-hospital outcome: insights from the PIPPAS multicentric study of 1387 cases in Spain

Magnesium degradation-induced variable fixation plates promote bone healing in rabbits

Preoperative antibiotic prophylaxis and the incidence of surgical site infections in elective clean soft tissue surgery of the hand and upper limb: a systematic review and meta-analysis

Keynote series | Spotlight on menopause

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Effect of different lumbar–iliac fixation and sacral slope for Tile C1.3 pelvic fractures: a biomechanical study

TikTok content as a source of health education regarding epicondylitis: a content analysis

Comparison of survival, function and complication between intercalary frozen autograft versus massive allograft reconstruction after malignant bone tumors resection

Optimizing periprosthetic fracture management and in-hospital outcome: insights from the PIPPAS multicentric study of 1387 cases in Spain

Magnesium degradation-induced variable fixation plates promote bone healing in rabbits

Preoperative antibiotic prophylaxis and the incidence of surgical site infections in elective clean soft tissue surgery of the hand and upper limb: a systematic review and meta-analysis