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 ¹ , XIONG Ying ³ , YUE Bolin ¹ , YANG Xi ¹ , XU Yongqing ¹ ,  SU Yongyue ¹

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

Citation： PAN De, HE Xiaoqing, XIONG Ying, YUE Bolin, YANG Xi, XU Yongqing, SU Yongyue. Application of bridge combined fixation system in pediatric Bado type Ⅰ chronic Monteggia fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(12): 1516-1520. doi: 10.7507/1002-1892.202509070 Copy

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.	安晋宇, 李桂军, 高立波, 等. 肱骨干骨折两种桥接系统固定方式比较. 中国矫形外科杂志, 2021, 29(15): 1350-1354.
11.	樊友亮, 许海云, 夏铭阳, 等. 桥接组合固定与重建钢板固定锁骨骨折的比较. 中国矫形外科杂志, 2021, 29(24): 2214-2218.
12.	高磊, 吴一雄, 胡辉东, 等. 桥接组合式内固定系统与重建钢板治疗肩胛骨骨折. 中国矫形外科杂志, 2020, 28(12): 1089-1093.
13.	陆继鹏, 杨慧勤, 吴中雄, 等. 桥接系统外固定治疗儿童胫骨骨折. 中国矫形外科杂志, 2020, 28(16): 1532-1534.
14.	熊鹰, 陆继鹏, 王大兴, 等. 桥接组合式内固定系统治疗肱骨及胫骨骨折的临床应用研究. 中国矫形外科杂志, 2010, 18(14): 1209-1211.
15.	汪亮, 王忍, 顾卫东, 等. 桥接组合式内固定系统外固定治疗开放性胫骨中下段骨折. 中国骨伤, 2021, 34(2): 148-152.
16.	王雨辰, 俞伟忠. 桥接组合式内固定系统的临床应用及生物力学研究进展. 中国矫形外科杂志, 2017, 25(24): 2256-2258.
17.	张庆文, 柴瑞宝. 桥接组合式内固定系统治疗胫骨粉碎性骨折的疗效分析. 中国矫形外科杂志, 2014, 22(18): 1715-1717.

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. 安晋宇, 李桂军, 高立波, 等. 肱骨干骨折两种桥接系统固定方式比较. 中国矫形外科杂志, 2021, 29(15): 1350-1354.
11. 樊友亮, 许海云, 夏铭阳, 等. 桥接组合固定与重建钢板固定锁骨骨折的比较. 中国矫形外科杂志, 2021, 29(24): 2214-2218.
12. 高磊, 吴一雄, 胡辉东, 等. 桥接组合式内固定系统与重建钢板治疗肩胛骨骨折. 中国矫形外科杂志, 2020, 28(12): 1089-1093.
13. 陆继鹏, 杨慧勤, 吴中雄, 等. 桥接系统外固定治疗儿童胫骨骨折. 中国矫形外科杂志, 2020, 28(16): 1532-1534.
14. 熊鹰, 陆继鹏, 王大兴, 等. 桥接组合式内固定系统治疗肱骨及胫骨骨折的临床应用研究. 中国矫形外科杂志, 2010, 18(14): 1209-1211.
15. 汪亮, 王忍, 顾卫东, 等. 桥接组合式内固定系统外固定治疗开放性胫骨中下段骨折. 中国骨伤, 2021, 34(2): 148-152.
16. 王雨辰, 俞伟忠. 桥接组合式内固定系统的临床应用及生物力学研究进展. 中国矫形外科杂志, 2017, 25(24): 2256-2258.
17. 张庆文, 柴瑞宝. 桥接组合式内固定系统治疗胫骨粉碎性骨折的疗效分析. 中国矫形外科杂志, 2014, 22(18): 1715-1717.

Chinese Journal of Reparative and Reconstructive Surgery

Application of bridge combined fixation system in pediatric Bado type Ⅰ chronic Monteggia fractures

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