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ISSN 2007-087X (Print)
Órgano Oficial de la Sociedad Mexicana de Ortopedia Pediátrica

2018, Number 2

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Rev Mex Ortop Ped 2018; 20 (2)

Surgical treatment of chronic Monteggia fractures in children: a systematic review of the literature

Masquijo JJ, Tourn D, Torres-Gomez A

Language: English
References: 27
Page: 66-71
PDF size: 123.40 Kb.


ABSTRACT

Introduction: Monteggia fractures are rare. When diagnosed late represent a major challenge for the surgeon. Several techniques are described for the surgical treatment of this condition. We conducted a systematic review of the literature to: define the level of evidence regarding reconstruction surgery, determine whether surgery improves function, and identify complications related to each treatment method. Methods: We reviewed the literature for all studies of surgical treatment of chronic Monteggia fractures. We analyzed English-language studies that evaluated functional outcomes in patients less than 18 years with 1-year minimum follow-up. We divided the patients into three groups according to treatment received: A) Reconstruction of the annular ligament, B) Osteotomy of the ulna and C) Combination of both techniques. Two researchers according to The Newcastle -Ottawa Scale (NOS) assessed the quality of evidence independently. Results: We analyzed 17 studies that met our inclusion criteria. All belonged to a level of evidence IV. According to NOS the average score was 8.7 points (8.4-9.5). The sample consisted of 241 patients (11-33): 22 patients in group A, 84 in group B, and 135 in group C. Group B showed a tendency to regain a higher range of motion than groups A and C. Group A showed a mean improvement of flexion-extension of 20° and decreased pronation-supination 10o. Group B improved 30° and 18° respectively. Complication rate was significantly inferior in group B, 50, 25 and 43.7% respectively (p = 0.0022). Discussion: Current evidence regarding reconstruction surgery in chronic Monteggia fractures is level IV and suggests that different surgical techniques are associated with improved function but are associated with a high rate of complications.


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