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Meta-Analysis
. 2023 Jul;143(7):4085-4093.
doi: 10.1007/s00402-022-04576-1. Epub 2022 Sep 3.

Monteggia fractures and Monteggia-like-lesions: a systematic review

Marc Maximilian Weber  1 , Thomas Rosteius  2 , Thomas A Schildhauer  2 , Matthias Königshausen  2 , Valentin Rausch  3
Affiliations
Meta-Analysis

Monteggia fractures and Monteggia-like-lesions: a systematic review

Marc Maximilian Weber et al. Arch Orthop Trauma Surg. 2023 Jul.

Abstract

Monteggia injuries are rare, but severe injuries of the elbow including various injury patterns. Treatment of these injuries is still topic of debate and strategies differ widely. In this systematic review on Monteggia injuries in adults, we aimed to clarify the incidence of different injury patterns within Monteggia injuries, investigate the main reasons leading to revision surgery and explore which surgical treatments should be favored to achieve satisfactory clinical results.We initially identified 182 publications and ultimately included 17 retrospective studies comprising 651 cases. All patients were classified using the Bado classification, leading to 30.5% Bado type I fractures, 60.4% type II fractures, 5.1% type III and 3.1% type IV fractures. Mean revision rate was 23%. Ulna non-union (28%) and limited range-of-motion (22%) are the main reasons for revision surgery. Meta-analysis shows a trend toward the use of locking plates for ulna fixation which may lead to less revision surgery and fewer ulna non-unions. Further biomechanical and clinical research is necessary to clarify the role of radial head surgery.

Keywords: Coronoid fracture; Elbow dislocation; Elbow trauma; Monteggia injury; Olecranon fracture; Radial head fracture; Suture; Ulna non-union.

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Conflict of interest statement

No conflicts of interest or financial funding are declared by the authors.

Figures

Fig. 1
Fig. 1
PRISMA-adapted flowchart illustrating study selection and exclusion criteria
Fig. 2
Fig. 2
Bado classification of 651 patients and subclassification of 370 Bado type II fractures according to Jupiter
Fig. 3
Fig. 3
A Comparison of mean revision rates between publications using locking compression plates (LCP) for ulna fixation (n = 7) with publications not using locking compression plates (non-LCP; n = 9) rates. B overview of revision rates in 17 publications treating Monteggia injuries. C Comparison of ulna non-union rates between publications using locking compression plates (LCP) for ulna fixation (n = 7) with publications not using locking compression plates (non-LCP; n = 9). D Overview of ulna non-union rates in 17 publications treating Monteggia injuries
See this image and copyright information in PMC

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