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Background <p>The factors predicting the development of heterotopic ossification (HO) of the elbow in children with untreated chronic Monteggia fractures (UCMFs) remained unclear. This multicentre study was designed to evaluate the radiographic data from paediatric patients with UCMFs and to identify the risk factors for HO formation and their radiographic characteristics.</p> Materials and methods <p>We retrospectively reviewed 274 patients (mean age at injury: 5.82 ± 2.62&#xa0;years) with UCMFs with all types of anterior (group A) and non-anterior (group B) radial head (RH) dislocations. Radiographs were used to assess the presence, size and bone density of HO. The risk factors evaluated included age at injury, sex, laterality, interval from injury to diagnosis, presence of radial or median nerve injury, immobilization of the fractured ulna after injury, direction of RH dislocation and distance of RH dislocation (DD-RH). The results were compared with 76 patient demographics-matched paediatric acute Monteggia fractures (PAMFs) undergoing surgery within 48&#xa0;h after injury.</p> Results <p>The HO rate (13.1%) in children with UCMFs was significantly higher than that (0%) in children with PAMFs (<i>P</i> = 0.001). The incidence of HO (14.5%) in group A was significantly higher than that (0%) in group B (<i>P</i> = 0.032). Age at injury and DD-RH were confirmed as risk factors for HO in patients with UCMFs by both univariate and logistic regression analyses (<i>P</i> &lt; 0.05). Receiver operating characteristic curve analysis and chi-squared analysis indicated that age at injury &gt; 6.78&#xa0;years and DD-RH &lt; 1.59-fold of the narrowest radial neck width were the cut-off values for an increased HO rate in patients with UCMFs (<i>P</i> &lt; 0.05). Increased age at injury (<i>P</i> = 0.041) and interval from injury to diagnosis (<i>P</i> = 0.006) were associated with high-bone density HO.</p> Conclusions <p>Patients with UCMFs with anterior RH dislocations, age at injury &gt; 6.78&#xa0;years, and DD-RH &lt; 1.59-fold of the narrowest radial neck width were more likely to develop HO. The bone density of HO increases with age at injury and interval from injury to diagnosis. Timely RH reduction after acute injury may prevent HO.</p> <p><i>Level of evidence</i>: III.</p>

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Risk factors for the development of heterotopic ossification of the elbow in children with untreated chronic Monteggia fractures: a radiographic review of 274 cases

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  • 发表日期：

    2025年4月26日

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  • WenTao Wang,
  • QianQian Mei,
  • ChongZhi Zhao,
  • Antonio Andreacchio,
  • ShengPing Tang,
  • Hang Liu,
  • ShunYou Chen,
  • Zhu Xiong,
  • Federico Canavese,
  • ShengHua He

摘要

Background

The factors predicting the development of heterotopic ossification (HO) of the elbow in children with untreated chronic Monteggia fractures (UCMFs) remained unclear. This multicentre study was designed to evaluate the radiographic data from paediatric patients with UCMFs and to identify the risk factors for HO formation and their radiographic characteristics.

Materials and methods

We retrospectively reviewed 274 patients (mean age at injury: 5.82 ± 2.62 years) with UCMFs with all types of anterior (group A) and non-anterior (group B) radial head (RH) dislocations. Radiographs were used to assess the presence, size and bone density of HO. The risk factors evaluated included age at injury, sex, laterality, interval from injury to diagnosis, presence of radial or median nerve injury, immobilization of the fractured ulna after injury, direction of RH dislocation and distance of RH dislocation (DD-RH). The results were compared with 76 patient demographics-matched paediatric acute Monteggia fractures (PAMFs) undergoing surgery within 48 h after injury.

Results

The HO rate (13.1%) in children with UCMFs was significantly higher than that (0%) in children with PAMFs (P = 0.001). The incidence of HO (14.5%) in group A was significantly higher than that (0%) in group B (P = 0.032). Age at injury and DD-RH were confirmed as risk factors for HO in patients with UCMFs by both univariate and logistic regression analyses (P < 0.05). Receiver operating characteristic curve analysis and chi-squared analysis indicated that age at injury > 6.78 years and DD-RH < 1.59-fold of the narrowest radial neck width were the cut-off values for an increased HO rate in patients with UCMFs (P < 0.05). Increased age at injury (P = 0.041) and interval from injury to diagnosis (P = 0.006) were associated with high-bone density HO.

Conclusions

Patients with UCMFs with anterior RH dislocations, age at injury > 6.78 years, and DD-RH < 1.59-fold of the narrowest radial neck width were more likely to develop HO. The bone density of HO increases with age at injury and interval from injury to diagnosis. Timely RH reduction after acute injury may prevent HO.

Level of evidence: III.