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Outcomes After Operative Treatment of Pediatric Monteggia Fracture-Dislocations: Comparison Between Open and Closed Injuries.
- Source :
-
Journal of pediatric orthopedics [J Pediatr Orthop] 2022 Aug 01; Vol. 42 (7), pp. 361-366. Date of Electronic Publication: 2022 May 10. - Publication Year :
- 2022
-
Abstract
- Background: Open pediatric Monteggia fracture-dislocations are a relatively uncommon injury pattern, with limited numbers reported in previous series. Open fracture-dislocations frequently represent more severe injury patterns with potential for contamination. We aim to determine differences in long-term clinical and functional outcomes in the operative management of closed versus open pediatric Monteggia fracture-dislocations.<br />Methods: A retrospective review of operatively treated pediatric Monteggia fracture-dislocations was performed. Closed versus open injuries were compared in both clinical outcomes, as well as patient-reported outcomes through Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire.<br />Results: Of 30 operatively treated injuries, 12/30 (40%) were open fracture-dislocations. Patients were followed clinically for an average of 15.65 months in open injuries and an average of 4.61 months in closed injuries. A trend toward increased time to union was observed, however, significance was not achieved; open injuries averaged 8.0 versus 5.8 weeks for closed injuries ( P =0.07). Two patients (11%) in the closed fracture group experienced postoperative complications; both were minor. Five patients (42%) in the open fracture-dislocation group experienced a total of 6 postoperative complications; 5 of the 6 complications were major. QuickDASH scores were obtained at an average of 5 years postoperatively; mean QuickDASH scores were higher in the open fracture group, 13.1, compared with the closed fracture group, 5.9 ( P =0.038). Increased QuickDASH scores were independently associated with presence of postoperative complications. QuickDASH score could be expected to increase by 12.5 points in those with major complications ( P =0.044).<br />Conclusion: We present the largest single cohort of pediatric open Monteggia fracture-dislocation injuries to date. These injuries are predictive of poorer outcomes including trend toward increased time to union, increased risk of major complication, and can independently predict worse long-term patient-reported functional outcomes.<br />Level of Evidence: Level III-these data represent a retrospective comparative study of clinical and functional outcomes.<br />Competing Interests: The authors declare no conflicts of interest.<br /> (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Child
Fracture Fixation, Internal adverse effects
Humans
Postoperative Complications etiology
Retrospective Studies
Treatment Outcome
Fractures, Closed surgery
Fractures, Open surgery
Joint Dislocations complications
Joint Dislocations surgery
Monteggia's Fracture complications
Ulna Fractures complications
Subjects
Details
- Language :
- English
- ISSN :
- 1539-2570
- Volume :
- 42
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Journal of pediatric orthopedics
- Publication Type :
- Academic Journal
- Accession number :
- 35543603
- Full Text :
- https://doi.org/10.1097/BPO.0000000000002171