Application of bridge combined fixation system in pediatric Bado type <b>Ⅰ</b> chronic Monteggia fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PAN De ^1,2 , HE Xiaoqing ² , XIONG Ying ³ , YUE Bolin ² , YANG Xi ² , XU Yongqing ² ,  SU Yongyue ²

1. Clinical College of Dali University, Dali Yunnan, 671000, P. R. China;
2. Department of Orthopedic Surgery, 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China;
3. Department of Orthopedic Surgery, Yan’an Hospital, Kunming Yunnan, 650051, P. R. China;

Corresponding?author：

SU Yongyue, Email: drsuyy@qq.com

Keywords：

Bridge combined fixation system; chronic Monteggia fracture; fracture fixation; child

DOI：

10.7507/1002-1892.202509070

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Objective To investigate effectiveness of the bridge combined fixation system (BCFS) for Bado typeⅠchronic Monteggia fractures (CMF) in children. Methods A clinical data of 8 children with Bado type ⅠCMF, who were treated with the BCFS between November 2023 and February 2025, was retrospectively analyzed. There were 6 boys and 2 girls, with a mean age of 7.0 years (range, 4-12 years). The time from injury to operation ranged from 29 to 370 days (median, 68.5 days). Preoperative elbow range of motion was (111.3±17.9)° in flexion, (13.1±13.9)° in extension, (71.9±14.6)° in pronation, and (75.6±13.5)° in supination. Fracture healing time and postoperative complications were observed, and clinical outcomes were evaluated using the Mayo elbow performance score. Results All incisions healed by primary intention without infection, non-healing of the incision, or iatrogenic nerve injury. All children were followed up 4-18 months (mean, 10.3 months). At last follow-up, the elbow range of motion significantly improved to (142.5±2.7)° in flexion, (2.5±2.7)° in extension, (87.5±2.7)° in pronation, and (88.8±2.3)° in supination (P<0.05). According to the postoperative Mayo elbow performance score, all cases were rated as excellent. Radiographic review showed no radial head dislocation, nonunion at the ulnar osteotomy site, or elbow stiffness, and no breakage of the BCFS or screw loosening. The fracture healing time ranged from 3 to 6 months, with a median of 4 months. Conclusion The BCFS was confirmed to be effective in the treatment of pediatric Bado type Ⅰ CMF, with good restoration of elbow function and the advantage of avoiding secondary implant removal surgery.

1.	Bado JL. The Monteggia lesion. Clin Orthop Relat Res, 1967, 50: 71-86.
2.	Hubbard J, Chauhan A, Fitzgerald R, et al. Missed pediatric Monteggia fractures. JBJS Rev, 2018, 6(6): e2. doi: 10.2106/JBJS.RVW.17.00116.
3.	Gleeson AP, Beattie TF. Monteggia fracture-dislocation in children. J Accid Emerg Med, 1994, 11(3): 192-194.
4.	Liao S, Pan J, Lin H, et al. A new approach for surgical treatment of chronic Monteggia fracture in children. Injury, 2019, 50(6): 1237-1241.
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6.	Stragier B, De Smet L, Degreef I. Long-term follow-up of corrective ulnar osteotomy for missed Monteggia fractures in children. J Shoulder Elbow Surg, 2018, 27(11): e337-e343.
7.	Lu X, Kun Wang Y, Zhang J, et al. Management of missed Monteggia fractures with ulnar osteotomy, open reduction, and dual-socket external fixation. J Pediatr Orthop, 2013, 33(4): 398-402.
8.	Yuan Z, Xu HW, Liu YZ, et al. The use of external fixation for the management of acute and chronic Monteggia fractures in children. J Child Orthop, 2019, 13(6): 551-559.
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11.	樊友亮, 許海云, 夏銘陽, 等. 橋接組合固定與重建鋼板固定鎖骨骨折的比較. 中國矯形外科雜志, 2021, 29(24): 2214-2218.
12.	高磊, 吳一雄, 胡輝東, 等. 橋接組合式內固定系統與重建鋼板治療肩胛骨骨折. 中國矯形外科雜志, 2020, 28(12): 1089-1093.
13.	陸繼鵬, 楊慧勤, 吳中雄, 等. 橋接系統外固定治療兒童脛骨骨折. 中國矯形外科雜志, 2020, 28(16): 1532-1534.
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15.	汪亮, 王忍, 顧衛東, 等. 橋接組合式內固定系統外固定治療開放性脛骨中下段骨折. 中國骨傷, 2021, 34(2): 148-152.
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1. Bado JL. The Monteggia lesion. Clin Orthop Relat Res, 1967, 50: 71-86.
2. Hubbard J, Chauhan A, Fitzgerald R, et al. Missed pediatric Monteggia fractures. JBJS Rev, 2018, 6(6): e2. doi: 10.2106/JBJS.RVW.17.00116.
3. Gleeson AP, Beattie TF. Monteggia fracture-dislocation in children. J Accid Emerg Med, 1994, 11(3): 192-194.
4. Liao S, Pan J, Lin H, et al. A new approach for surgical treatment of chronic Monteggia fracture in children. Injury, 2019, 50(6): 1237-1241.
5. Zivanovic D, Marjanovic Z, Bojovic N, et al. Neglected Monteggia fractures in children-a retrospective study. Children (Basel), 2022, 9(8): 1100. doi: 10.3390/children9081100.
6. Stragier B, De Smet L, Degreef I. Long-term follow-up of corrective ulnar osteotomy for missed Monteggia fractures in children. J Shoulder Elbow Surg, 2018, 27(11): e337-e343.
7. Lu X, Kun Wang Y, Zhang J, et al. Management of missed Monteggia fractures with ulnar osteotomy, open reduction, and dual-socket external fixation. J Pediatr Orthop, 2013, 33(4): 398-402.
8. Yuan Z, Xu HW, Liu YZ, et al. The use of external fixation for the management of acute and chronic Monteggia fractures in children. J Child Orthop, 2019, 13(6): 551-559.
9. Hasler CC, Von Laer L, Hell AK. Open reduction, ulnar osteotomy and external fixation for chronic anterior dislocation of the head of the radius. J Bone Joint Surg (Br), 2005, 87(1): 88-94.
10. 安晉宇, 李桂軍, 高立波, 等. 肱骨干骨折兩種橋接系統固定方式比較. 中國矯形外科雜志, 2021, 29(15): 1350-1354.
11. 樊友亮, 許海云, 夏銘陽, 等. 橋接組合固定與重建鋼板固定鎖骨骨折的比較. 中國矯形外科雜志, 2021, 29(24): 2214-2218.
12. 高磊, 吳一雄, 胡輝東, 等. 橋接組合式內固定系統與重建鋼板治療肩胛骨骨折. 中國矯形外科雜志, 2020, 28(12): 1089-1093.
13. 陸繼鵬, 楊慧勤, 吳中雄, 等. 橋接系統外固定治療兒童脛骨骨折. 中國矯形外科雜志, 2020, 28(16): 1532-1534.
14. 熊鷹, 陸繼鵬, 王大興, 等. 橋接組合式內固定系統治療肱骨及脛骨骨折的臨床應用研究. 中國矯形外科雜志, 2010, 18(14): 1209-1211.
15. 汪亮, 王忍, 顧衛東, 等. 橋接組合式內固定系統外固定治療開放性脛骨中下段骨折. 中國骨傷, 2021, 34(2): 148-152.
16. 王雨辰, 俞偉忠. 橋接組合式內固定系統的臨床應用及生物力學研究進展. 中國矯形外科雜志, 2017, 25(24): 2256-2258.
17. 張慶文, 柴瑞寶. 橋接組合式內固定系統治療脛骨粉碎性骨折的療效分析. 中國矯形外科雜志, 2014, 22(18): 1715-1717.

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