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Examining Preoperative Risk Factors for Nerve Injury in Pediatric Monteggia Fracture-Dislocations.
Jason Zarahi Amaral1, Basel M Touban, Rebecca J Schultz
1Division of Orthopedic Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
The Journal of Bone and Joint Surgery. American Volume
|March 6, 2025
Summary
Pediatric Monteggia fracture-dislocations have an 18.2% incidence of nerve injury, with older age and specific fracture patterns being key risk factors. Fortunately, all nerve injuries resolved spontaneously within 150 days.
Area of Science:
- Pediatric Orthopedics
- Pediatric Traumatology
- Nerve Injury Research
Background:
- Understanding risk factors for nerve injury in pediatric Monteggia fracture-dislocations is crucial.
- Pediatric Monteggia fracture-dislocations present a significant risk for associated nerve damage.
- The incidence and specific preoperative risk factors for nerve injury in this population remain poorly defined.
Purpose of the Study:
- To determine the incidence of preoperative nerve injury in pediatric Monteggia fracture-dislocations.
- To identify preoperative risk factors associated with nerve injury in pediatric Monteggia fracture-dislocations.
- To evaluate the resolution time and outcomes of nerve injuries in this pediatric cohort.
Main Methods:
- Retrospective review of 148 pediatric patients (age ≤18) with Monteggia or equivalent fracture-dislocations from 2011-2021.
- Exclusion of patients with emergency department reductions, concomitant upper extremity fractures, malunions, or missing preoperative imaging.
- Logistic regression analysis controlled for age and fracture pattern to identify preoperative risk factors for nerve injury.
Main Results:
- 18.2% of patients experienced preoperative nerve injury, with the posterior interosseous nerve (PIN) and anterior interosseous nerve (AIN) most commonly affected.
- Significant risk factors for nerve injury included patient age ≥8 years, lateral radial head dislocation, open fracture, and comminuted ulnar fracture.
- PIN injury correlated with lateral radial head dislocation and comminuted ulnar fracture; AIN injury correlated with open and diaphyseal ulnar fractures.
Conclusions:
- The incidence of preoperative nerve injury in pediatric Monteggia fracture-dislocations is 18.2%.
- Age ≥8 years, lateral radial head dislocation, open fracture, and comminuted ulnar fracture are significant preoperative risk factors.
- Spontaneous resolution of all nerve injuries within 150 days suggests non-operative management may be sufficient, potentially avoiding early surgical intervention.
